License Verification

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JERRY LEE STORK JR

License Number: PA9103513

Data As Of 6/10/2024

Profession
Physician Assistant
License
PA9103513
License Status
CLEAR/Active
License Expiration Date
1/31/2026
License Original Issue Date
09/23/2005
Address of Record

This practitioner does not have an address of record on file with the department. If you have any questions, please contact the department at (850) 488-0595.

Address of Record
NOT PRACTICING
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
168 Broken Arrow Trail
PETAL, MS 39465
Address
15200 Community Rd
PETAL, MS 39465
Name Relationship Profession License Effective Date
ALONSO, LEONARDO LAZARO Supervising Prescribing Practitioner Osteopathic Physician 6584 12/19/2018
ATTLESEY, MARK GRAHAM Supervising Prescribing Practitioner Medical Doctor 71653 12/20/2018
AYCOCK, RYAN DON Supervising Prescribing Practitioner Medical Doctor 118284 09/26/2018
BAKOR, NADIA Supervising Prescribing Practitioner Medical Doctor 131303 12/20/2018
BARKHUIZEN, CHRISTY H DO Supervising Prescribing Practitioner Osteopathic Physician 9479 09/26/2018
BEAZLEY, WILLIAM WALTON DO Supervising Prescribing Practitioner Osteopathic Physician 9930 09/26/2018
BESSER, KATHLEEN CORINNE DO Supervising Prescribing Practitioner Osteopathic Physician 11756 09/26/2018
BLAKE, STEVEN MITCHELL M D Supervising Prescribing Practitioner Medical Doctor 58519 12/20/2018
BRUNIOUS, BURNELL PAUL Supervising Prescribing Practitioner Medical Doctor 104848 09/26/2018
CASTELLON-VOGEL, CARLOS H MD Supervising Prescribing Practitioner Medical Doctor 46096 09/26/2018
CHAPMAN, JENNIFER COLES Supervising Prescribing Practitioner Medical Doctor 125751 12/20/2018
CLONTZ, ROBERT MICHAEL II Supervising Prescribing Practitioner Medical Doctor 129523 09/26/2018
DAVIS, DAVID RICHARD Supervising Prescribing Practitioner Medical Doctor 96442 12/20/2018
DESCALLAR, EDWARD ALLEN Supervising Prescribing Practitioner Medical Doctor 135003 12/20/2018
DEUTSCH, LEISA MARIE ROSSELLO Supervising Prescribing Practitioner Medical Doctor 134059 09/26/2018
DURANT, CHRISTOPHER Supervising Prescribing Practitioner Osteopathic Physician 12105 09/26/2018
EUWEMA, MICHAEL SCOTT Supervising Prescribing Practitioner Medical Doctor 91648 12/20/2018
FARR, JORDAN TAYLOR Supervising Prescribing Practitioner Osteopathic Physician 15015 12/20/2018
GONZALES, LEO T Supervising Prescribing Practitioner Medical Doctor 74826 09/26/2018
GOODFRIEND, STEVEN DAVID Supervising Prescribing Practitioner Medical Doctor 84608 12/19/2018
GROVES, KEVIN DALE Supervising Prescribing Practitioner Medical Doctor 105815 09/26/2018
HAYNES, DAVID W Supervising Prescribing Practitioner Osteopathic Physician 11905 09/26/2018
HYBART, JOHN L MD Supervising Prescribing Practitioner Medical Doctor 22382 09/26/2018
JENKINS, FREDERICK LUCAS Supervising Prescribing Practitioner Medical Doctor 83245 12/20/2018
KAUFMAN, NESREEN HANNA Supervising Prescribing Practitioner Medical Doctor 121116 09/26/2018
KEENER, JANEL LAURA Supervising Prescribing Practitioner Medical Doctor 115434 12/20/2018
KING, FORREST JOSEPH Supervising Prescribing Practitioner Medical Doctor 124146 12/20/2018
KING, KENNETH Supervising Prescribing Practitioner Osteopathic Physician 8648 12/20/2018
KOURY, RONALD FORREST D O Supervising Prescribing Practitioner Osteopathic Physician 8090 12/20/2018
LAMOND, RYAN DANIEL Supervising Prescribing Practitioner Medical Doctor 106090 12/19/2018
LISS, BENJAMIN EDWARD Supervising Prescribing Practitioner Medical Doctor 127752 09/26/2018
MATHAI, ALEX Supervising Prescribing Practitioner Medical Doctor 122229 12/20/2018
MENZE, ROGER MICHEEL Supervising Prescribing Practitioner Medical Doctor 68199 12/20/2018
MORRISON, EDWARD SCOTT Supervising Prescribing Practitioner Osteopathic Physician 8010 09/26/2018
NAVARRO, GUILLERMO ALBERTO Supervising Prescribing Practitioner Medical Doctor 135153 09/26/2018
NAVO, DAVID JOEL JR Supervising Prescribing Practitioner Medical Doctor 135494 09/26/2018
OLIVER, RADAMES ALBERTO Supervising Prescribing Practitioner Medical Doctor 67906 12/19/2018
PAPAVASILIOU, JOHN JOSEPH Supervising Prescribing Practitioner Medical Doctor 66371 12/19/2018
PERRY, DEBRA L Supervising Prescribing Practitioner Medical Doctor 119490 09/26/2018
QUADER, MOHAMMED AZIZUL Supervising Prescribing Practitioner Medical Doctor 91402 12/19/2018
REESE, JOHN LANCE Supervising Prescribing Practitioner Medical Doctor 63197 09/26/2018
ROSEL, GEORGANNA MICHELLE Supervising Prescribing Practitioner Medical Doctor 134082 12/20/2018
SCHRANDT, ERIC Supervising Prescribing Practitioner Medical Doctor 136791 09/26/2018
SEAMAN, RYAN J Supervising Prescribing Practitioner Osteopathic Physician 12746 09/26/2018
SLOTT, EDWIN FREDERICK Supervising Prescribing Practitioner Medical Doctor 120515 12/19/2018
STAVROS, MARK GEORGE Supervising Prescribing Practitioner Medical Doctor 71124 09/26/2018
SUMRALL, ARTHUR TIMOTHY II Supervising Prescribing Practitioner Medical Doctor 94665 09/26/2018
SWANSON, TERRELL E JOHN Supervising Prescribing Practitioner Medical Doctor 111251 12/20/2018
TAUNTON, STEPHANIE S Supervising Prescribing Practitioner Medical Doctor 123074 09/26/2018
THOMAS, ROBERT LOUIS Supervising Prescribing Practitioner Osteopathic Physician 8592 09/26/2018
WALLACE, MOIRA PETIRS Supervising Prescribing Practitioner Medical Doctor 133941 12/20/2018
WARD, JILL ANGELA Supervising Prescribing Practitioner Medical Doctor 110689 12/20/2018
WARRINGTON, STEVEN Supervising Prescribing Practitioner Medical Doctor 131907 12/20/2018
WHEELER, MARERIL Supervising Prescribing Practitioner Medical Doctor 126534 12/20/2018
WILSON, ZACHARY WAYNE Supervising Prescribing Practitioner Medical Doctor 117252 09/26/2018
WINNINGHAM, DAVID JASON Supervising Prescribing Practitioner Osteopathic Physician 12586 12/20/2018
WRIGHT, GARY DAVID Supervising Prescribing Practitioner Medical Doctor 116465 09/26/2018
ZAHERI, KAMRAN Supervising Prescribing Practitioner Medical Doctor 136667 10/01/2018
ZAVORAL, THOMAS WAYNE JR Supervising Prescribing Practitioner Medical Doctor 98270 09/26/2018
ZEATON, KARIN ELIZABETH Supervising Prescribing Practitioner Osteopathic Physician 10311 12/20/2018
ZERNIAL, CHRISTOPHER B Supervising Prescribing Practitioner Medical Doctor 131593 12/20/2018

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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 6/10/2024



* 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.