Physician Assistant Initial Application and Forms


In order to comply with federal law, the West Virginia Board of Medicine is obligated to inform each applicant or licensee from whom it requests a Social Security Number that disclosing such number is MANDATORY in order for this Board to comply with the requirements of the federal National Practitioner Data Bank and the Healthcare Integrity and Protection Data Bank. If this Board should be required to make a report about one of its applicants or licensees to either of these data banks, it must report that individual’s Social Security Number.

In order to practice as a physician assistant in West Virginia you must hold an active license and a Board authorized practice agreement with a collaborating physician.

Please carefully read the instructions before completing the application. Please DO NOT delegate the responsibility of completing applications to an office manager or assistant. 

If you have questions you may contact the Board’s Physician Assistant Licensure Analyst at 304.558.2921, ext. 70002.


Criminal History Record Check - Prior to issuance of initial licensure.