Physician Assistant Applications and Forms

**NOTICE**

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 reporting requirements of the National Practitioner Data Bank.

In order to practice as a physician assistant in West Virginia you must hold an active license and either a Board authorized Practice Agreement with a collaborating physician or an active Practice Notification.

To apply for an initial physician assistant license or reactivation of a license that has been expired for more than one year, please complete the Initial Physician Assistant Licensure Application.

Initial Physician Assistant Licensure Application

ADDTIONAL REQUIREMENT

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

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.