Physician Assistant Applications and Forms
To practice in West Virginia all physician assistants must hold an active status license or registration issued by the Board AND an activated Practice Notification.
APPLY FOR LICENSURE
To apply for an initial physician assistant license or reactivate a license that has been expired for more than one year, please complete the Physician Assistant Licensure Application.
All initial licensure applicants must also complete a Criminal History Record Check.
APPLY FOR REINSTATEMENT OF LICENSURE
To apply for reinstatement of a physician assistant license that has been expired for less than one year, please complete the Physician Assistant Reinstatement Application.
SUBMIT A PRACTICE NOTIFICATION
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.
ADDITIONAL INFORMATION AND FORMS
Physician Assistant Practice Act
Controlled Substance Dispensing Practitioner Registration Application for Physicians, Podiatric Physicians and Physician Assistants
Charitable Exemption Authorization for WVBOM Licensees
Charitable Exemption Authorization for Physician Assistant’s Licensed in Other States
Name Change Affidavit
Duplicate Wall License Request
If you have any questions, you may contact the licensure analyst assigned to your last name cohort.
Sara J. Fields - Licensure Analyst - Last Names A - G
Amal.N.Khan – Licensure Analyst - Last Names H - O
Jessica N. Luciano- Licensure Analyst - Last Names P - Z