Physician Assistant Applications and Forms

There are two primary pathways for physician licensure in West Virginia: (1) the traditional licensure pathway; and (2) the Universal Professional and Occupational Licensing Act of 2025 ("UPOLA”) pathway. All initial licensure applicants must complete a Criminal History Record Check.

Traditional Pathway. To apply for an initial physician assistant license or reactivate a license that has been expired for more than one year, please review the instructions and complete the Physician Assistant Licensure Application.

Physician Assistant Licensure Application

UPOLA Pathway. To utilize the UPOLA pathway, PAs must either: (1) establish residency in the state of West Virginia; or (2) be married to an active-duty member of the armed forces of the United States and have accompanied the member to an official permanent change of station to a military installation located in West Virginia and meet the statutory requirements for UPOLA licensure, including:

1. The applicant must be currently licensed, registered, or certified in at least one other state in the discipline applied for and at the same practice level as determined by the WVBOM;
2. The applicant’s license, registration, or certification is in good standing in all states in which the applicant holds a license, registration, or certification;
3. The applicant is licensed, registered, or certified by another state with minimum education requirements and, if applicable, work experience and clinical supervision requirements in effect, and the other state verifies that the person met those requirements in order to be licensed, registered, or certified in that state;
4. The applicant previously passed any examinations, written or clinical, required for the license, registration, or certification if required by the other state;
5. The applicant has not had a license, registration, or certificate revoked or has not voluntarily surrendered a license, registration, or certificate in any other state or country while under investigation for unprofessional conduct;
6. The applicant has not had any other form of discipline imposed by any other regulating entity: Provided, that if another state’s regulating entity has taken disciplinary action against the applicant, the Board may issue the license, registration, or certificate if it determines the cause of action in the other state was corrected and the matter fully resolved;
7. The applicant pays all applicable fees in this state; and
8. The applicant does not have a disqualifying criminal history.

Physician Assistants who do not meet these criteria are ineligible to use the UPOLA pathway and are invited to apply through the traditional pathway.

UPOLA Application Eligibility Requirements and Instructions

To apply for reinstatement of a physician assistant license that has been expired for less than one year, please complete the following reinstatement application.

Physician Assistant Reinstatement Application

A Practice Notification provides written notice to the Board that a physician assistant licensed by or otherwise registered with the Board will practice in collaboration with one or more physicians while practicing to patients in West Virginia.

A physician assistant shall not commence practice to West Virginia patients until a fully completed Practice Notification is filed with the Board and the Board notifies the physician assistant that the Practice Notification has been activated.

An activated Practice Notification authorizes a physician assistant to practice at the identified health care facilities in conformity with the physician assistant’s education, training and experience and in accord with the delineation of privileges granted to the physician assistant or other credentialing requirements of the health care facility.

Practice Notification Form and Instructions

Practice Notification Form A

Activated Practice Notifications

Information related to a physician assistant’s currently activated Practice Notification(s) is available for review on the physician assistant’s licensee profile, which may be accessed utilizing the Look Up a Doctor or PA search feature on the Board’s website. Emergency registrant authorizations/activations to practice are listed on the COVID-19 Emergency Registrations page. Interstate Telehealth Registrant authorizations/activations to practice are listed on the Interstate Telehealth Registrations page.

Termination of a Practice Notification

A physician assistant must immediately cease practicing upon the termination of a Practice Notification, and must submit a Notification of Termination of a Practice Notification to the Board within ten days of the termination.

If you have any questions, you may contact the licensure analyst assigned to your last name cohort.

Christina H. McNealy - Licensure Analyst - Last Names A - G

Christina.H.McNealy@wv.gov

Emilie G. Lloyd – Licensure Analyst - Last Names H - O

Emilie.G.Lloyd@wv.gov

Jessica N. Luciano- Licensure Analyst - Last Names P - Z

Jessica.N.Luciano@wv.gov