License Verification

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KYLE GENE COOPER

License Number: PA9105012

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9105012
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
06/08/2009
Address of Record
2400 S FERDON BLVD
SUITE A
CRESTVIEW, FL 32536
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
2400 Ferdon Blvd. Suite A Crestview Urgent Care
CRESTVIEW, FL 32539
Address
906 PALM BLVD. SOUTH NICEVILLE URGENT CARE
NICEVILLE, FL 32578
Name Relationship Profession License Effective Date
LATHAM, JOSHUA LUKE DO Supervising Prescribing Practitioner Osteopathic Physician 10027 03/03/2017
NOGGLE, TOMMY STEVEN MD Supervising Prescribing Practitioner Medical Doctor 93880 03/03/2017

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 12/23/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.