State of Nevada Board of Medical Examiners Application and Other Licensing Forms
Attention
Physicians:
Pursuant
to NRS 630.167, as part of the application process, you are required to submit
to a criminal background investigation. Upon receipt of your completed
application, your License Specialist will send you an authorization form, the
appropriate fingerprint cards, and instructions.
APPLICATION
FORMS
Physician Application for
Licensure (Mid-biennial)
(July 1, 2008 - June 30, 2009)
To apply for licensure as an Allopathic Physician (MD) in the state of
Nevada,
download this printable form (PDF File), which includes detailed instructions.
Physician Application for License Renewal
(2009 - 2011)
To renew your license as an Allopathic Physician (MD) in the state of
Nevada,
download this printable form (PDF File), which includes detailed instructions.
Physician Application for
Special Purpose Medical License
(Mid-biennial)
(July 1, 2008 - June 30, 2009)
To apply for licensure as a Special Purpose Allopathic Physician (MD) in the
state of
Nevada, download this printable form (PDF File), which includes
detailed instructions.
Physician Application for Special Purpose License
Renewal
(2009 - 2011)
To renew your license as an Allopathic Physician (MD) in the state of
Nevada,
download this printable form (PDF File), which includes detailed instructions.
Physician Application for Special
Volunteer Medical License
To apply for a Special Purpose Medical License in the state of Nevada,
download this printable form (PDF File), which includes detailed instructions.
Physician
Application for Status Change
To apply for status change from inactive to active status as an Allopathic
Physician (MD) in the state of Nevada, download this printable form (PDF File),
which includes detailed instructions.
Physician
Application for Licensure Reinstatement
(2007-2009)
To apply for reinstatement as a Physician Assistant in the state of Nevada,
download this printable form (PDF File), which includes detailed instructions.
Physician
Authorization for Criminal Background
Investigation
This form must be completed and submitted with an application for licensure as an
Allopathic Physician (MD) in the state of Nevada. Download this printable
form (PDF File), complete, and submit the form with the application.
Resident
Application for
Limited Medical License
(July
1, 2009 - June 30, 2010)
To apply for licensure as an a Resident in the state of Nevada, download this
printable form (PDF File), which includes detailed instructions.
Physician Assistant Application
for Licensure (Mid-biennial) (July
1, 2008 - June 30, 2009)
To apply for licensure as a Physician Assistant in the state of Nevada,
download this printable form (PDF File), which includes detailed instructions.
Physician
Assistant Application for License Renewal
(2009 - 2011)
To renew your license as a Physician
Assistant in the state of
Nevada,
download this printable form (PDF File), which includes detailed instructions.
Physician
Assistant Application for Licensure
Reinstatement
(2007-2009)
To apply for reinstatement as a Physician Assistant in the state of Nevada,
download this printable form (PDF File), which includes detailed instructions.
Practitioner
of Respiratory Care Application for Licensure
(Mid-biennial) (February
28, 2009 - February 28, 2010)
To apply for licensure as a Practitioner of Respiratory
Care in the state of Nevada,
download this printable form (PDF File), which includes detailed instructions.
Blood gas licenses are issued by the Bureau of Health Care Quality and
Compliance.
You can contact that agency by calling 800-225-3414 (toll free) or
775-687-4475.
Practitioner
of Respiratory Care Application for Licensure
Reinstatement
(2008-2010)
To apply for reinstatement as a Practitioner of Respiratory
Care in the state of
Nevada, download this printable form (PDF File), which includes detailed
instructions.
Notification
of Supervision of Physician Assistant To notify the Nevada State Board of Medical Examiners of supervision of
a Physician Assistant, download this printable form (PDF File).
Notification
of Collaboration with Advanced Practitioner
of Nursing To notify the Nevada State Board of Medical Examiners of collaboration with
an Advanced Practitioner of Nursing, download this printable form (PDF File).
Notification of Address
Change
To notify the Nevada State Board of Medical Examiners of change of practice address,
download this printable form (PDF File), complete and mail to
the Nevada State Board of Medical Examiners at P.O. Box 7238,
Reno, NV 89510-7238.
The Nevada State Board of Medical
Examiners utilizes Adobe Acrobat for the distribution of electronic versions of its
documents.
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