New Applicants

Summary of Physician Assistant Licensure Requirements

Instructions

1. Complete every section of the online application.
   1. $55.00 application fee payable by credit card.
2. Documents needing to be uploaded or mailed to the North Dakota Board of Medicine:
   1. A recent 2"x3" unmounted photo of yourself. If you choose to submit a paper photograph please follow these instructions:
      1. Original passport quality photograph. No computer scanned or polaroid photograph with thick backing.
      2. Close-up front view of head and shoulders no larger than 2" X 3" and no smaller than 2" X 2".
      3. Must have been taken within 90-120 days prior of submitting this application.
   2. You must submit the completed Criminal History Record Check Request and the Fingerprint Verification form and two fingerprint cards along with a money order of $41.25 made payable to the Office of the Attorney General. Please make sure your fingerprint cards 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 at the following address:  North Dakota Board of Medicine, 4204 Boulder Ridge Rd Suite 260, Bismarck, ND 58503. 
      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. Be sure all personal information is completed on the cards. Click here for instructions and example.
   3. You must direct the licensing board of each state/province where you have ever applied for any type of physician assistant license (regardless of whether the license was granted or not granted, is active or inactive, temporary or permanent, restricted or unrestricted) to provide the North Dakota Board of Medicine with verification of your licensure status.
3. Processing of your application will be faster if you upload where ever possible.
4. Please keep a copy of the completed contract and application forms for your own files.
5. Please click here to read the ND Board of Medicine's statement regarding PA practice in the state. 
6. Petition for Board Approved Practice
7. PA Credentialing Forms - click on the respective forms below to provide to clinics/hospitals and to your supervising physician(s) where you have worked during the past three years.  The forms must be completed and returned directly to the Board office by the facility/supervising physician to be considered primary source verified.  You can also find these letters on the bottom of our homepage in the QuickLinks section.
   
   PA Hospital - Clinic Reference Form - this form cannot be completed by a colleague.  It should be completed by medical staff services or your direct manager/administrator.
   PA Supervising Physician Reference Form 
   PA Affidavit

 

Click here to begin the online application process.

Paper applications are no longer being accepted.

Interviews

Any applicant may be required to appear before the Board of Medicine for an interview. An applicant should expect to appear for an interview if any derogatory information is brought to the attention of the Board during the application process.