Click on the “Start Here” link below to
start your Uniform Application.
DRUG DISPENSING APPLICATION FORM FOR PERIOD ENDING JUNE 30, 2013
Please contact the Board of Osteopathic
firstname.lastname@example.org or by phone at 304.558.6095 for licensing
ASSISTANT INITIAL LICENSE APPLICATION
PHYSICIAN ASSISTANT CHANGE OR ADDITION OF SUPERVISING PHYSICIAN(S)
AND OR CHANGE OR ADDITION OF JOB LOCATION(S)
PRESCRIPTIVE WRITING PRIVILEGE APPLICATION
REINSTATEMENT APPLICATION AND TEMP LICENSE APPROVAL
This application is for Physician Assistants whose
license has been expired or terminated for less than a year.
Physician assistants may now seek temporary
licensure approval while awaiting action upon a completed
reinstatement application. If you are seeking temporary approval while
your reinstatement application is pending, please make sure to indicate
this request on your application and enclose the temporary license fee
of $50.00 with your application. This fee is in addition to the
reinstatement application fee.
MEDICAL CORPORATION RENEWAL FORM
P.L.L.C. APPLICATION FORM
P.L.L.C. RENEWAL FORM