Apply for Physician Assistant License
Eligibility for Physician Assistant License
To be eligible to practice as a Physician Assistant (PA) in North Dakota, the PA must fill out an application for licensure, submit to a statewide and national criminal history record check, pay the required $105.00 fee and provide satisfactory proof of:
- Graduation/completion from an approved physician assistant program;
- Passage of the certifying examination of the National Commission on Certification of Physician Assistants;
- Good standing with the National Commission on Certification of Physician Assistants; and
- A history free of any finding by the board, any other state medical licensure board, or any court of competent jurisdiction, of the commission of any act that would constitute grounds for disciplinary action.
An applicant may be required to appear before the Board of Medicine for an interview if any derogatory information is brought to the attention of the Board during the application process.
Application Instructions
Please review the following instructions before applying for licensure. You will be asked to supply dates and information on your education, training, and employment within the last 10 years, and licensure from other states – so please have that information and dates ready BEFORE you fill out the application. Incorrect dates and information will lead to delay in the licensure process and may result in disciplinary action.
NOTE: By submitting the application, you are certifying that the information provided is true and correct to the best of your knowledge. You, the applicant, must be the one to fill out the Personal Questions. Failure to provide complete and accurate information will result in an investigation that will delay the licensure process and may result in disciplinary action and/or sanctions.
Where applicable, the following documents must be uploaded with the application or submitted by email. NOTE: as detailed below, some documents must be sent DIRECTLY from the source.
1. Certification with the National Commission on Certification of Physician Assistants
List dates and information on all education, training, examinations, and certification. Applicants must have an active certification with the National Commission on Certification of Physician Assistants for the entire period of licensure which will require graduation from a PA program accredited by ARC-PA and passing of the certifying examination. You will be required to upload your NCCPA certification with your application.
2. Employment
List all employment for the past 10 years. List the employment in chronological date order starting with the OLDEST information first. You will be required to fill in all gaps between dates.
The Board reserves the right to seek employment verifications directly from current or former employers in line with Board policies and procedures – specifically if certain derogatory information is noted in the application (for example, termination of previous employment for cause, arrests/convictions, etc.). If such verification is required, it will be noted on your task list. If verification is required, the facility will need to fill out and send this reference form. The form must be completed by the facility and sent directly to the Board.
3. Supervising Physician
Supervising physicians of the last three years will need to fill out this reference form and send directly to the Board.
4. National Practitioner Databank Report
Run a "self-query" report through the National Practitioner Data Bank and submit to the Board
5. Criminal History Record
Complete the Criminal Record Authorization and Fingerprint Verification Forms and submit a money order in the amount of $40.00.
- Proceed to a local law enforcement office, or other private company who provides fingerprinting services, and complete TWO fingerprint cards. You should call your local law enforcement office for times and locations if fingerprinting services are available. Please be sure to bring a photo ID. A small fee ($5-$10) may be required by the facility. The fingerprint technician doing your prints must complete the verification form per the instructions. Please also make sure your completed fingerprint cards and the fingerprint verification form are placed in a SEALED envelope by the fingerprint technician who took your prints with their signature written across the sealed edge of the envelope. You should then place the sealed envelope inside another envelope addressed for mailing to the Board. DO NOT BEND OR FOLD the fingerprint cards when mailing them to us as they will be rejected, and you will be required to be fingerprinted again. Review the following instructions for completing the fingerprint cards. MOST offices will have fingerprint cards available on sturdy cardstock. However, you may also download the fingerprint cards to take with you. Please fill in the highlighted areas.
- Send a check or money order in the amount of $40 payable to the Office of Attorney General.
- Mail the completed criminal history record check request and fingerprint verification forms, two fingerprint cards, and check or money order of $40.00 made payable to the Office of Attorney General, to the Board office at 4204 Boulder Ridge Rd Ste 260, Bismarck, ND 58503
6. Other State Licenses
Provide a list of all licenses applied for/obtained in any state/province where you have ever applied for a license (regardless of whether the license was granted or not granted, is active or inactive, temporary or permanent, restricted or unrestricted).
7. Photograph
Provide a recent photograph of yourself. This photograph must be of original passport quality, no larger than wallet size, and should be a close-up front view of head and shoulders, taken no longer than 120 days prior to filing the application.
8. Name Change Verification
If applicable, notarized photocopy of marriage certificate or legal name change document if your name differs from that on any of your documents.
9. Personal Data Questionnaire
As part of the application, you will be required to fill out a Personal Data Questionnaire. This must be filled out directly by YOU as the applicant. Please read the questions carefully. After answering the questions, you will be required to attest and affirm that you answered the questions truthfully and accurately and recognize that inaccurate information will result in delays in processing the application, and may result in an interview, denial of licensure, or other disciplinary action.
When in doubt – disclose!
Provide a thorough explanation for any “yes” answer along with supporting documentation. Failure to provide supporting documentation will result in a delay to the licensure process.
You will be asked whether you have ever been cited, arrested, charged, or convicted of any violation of any law, other than a minor traffic citation. You MUST answer “yes” to this question even if the matter was dismissed, expunged, subject to a diversion or deferred prosecution program, or otherwise set aside. If you answer “yes” to this question, it will be your responsibility to provide:
- A written explanation/narrative detailing the circumstances;
- A copy of the arrest, incident, and police report;
- Court documentation (i.e., docket, charging document, complaint, sentencing, judgements, court orders, etc.);
- If applicable, any court order assessment with diagnosis;
- If applicable, proof of compliance with probation (i.e., participation in any drug/alcohol/etc. programs; payment of fees, fines, or restitution; completion of community services; completion of restitution);
- If applicable, evidence of mitigation or rehabilitation (i.e., letters of recommendation, proof of volunteer work, completion of training or self-improvement efforts, etc.); and
- Completion of sentencing/judgement requirements.
10. Fee
As of August 1, 2023, a $105.00 application fee payable by credit card.
11. Practice Location
You will be asked about intended practice location in the application. Please review PA practice location requirements in North Dakota found on the Board's website. A physician assistant may only practice at a physician owned facility, a facility with privileging and credentialing systems in place, or at a facility licensed by the Department of Health and Human Services. If a physician assistant wants to practice independently in North Dakota at a rural, underserved area, he/she must petition the Board for approval to practice by completing this form.
12. Re-Entry to Practice
If it has been two or more years since you have practiced clinically, you will need to submit a re-entry to practice plan as part of your application. Please refer to the Board's Re-Entry to Practice Packet for more information.
IMPORTANT – You have the option to Save your applicant and resume at a later time. If you do save, you will need to login to the Continued Save Application portal to continue applying. DO NOT LOG INTO YOUR ACCOUNT through any other portal. Loggin in through another portal will not access your saved application and will result in redundant applications being submitted – which will delay the administrative process.
Pursuant to North Dakota Century Code section 43-51.1-03(11), an applicant aggrieved by a licensure delay must first try to resolve the matter with the Board. If the matter cannot be resolved between the applicant and the Board, the applicant may bring the matter to the Governor's Office by emailing governor@nd.gov.