State of Nevada

Nevada State Board of Medical Examiners

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Page Last Updated: 03/20/14 08:22:38 AM

APPLICATIONS & OTHER LICENSING FORMS


Attention Applicant:

 

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.


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To apply for licensure as an Allopathic Physician (MD) in the state of Nevada, please choose one of the following:

 

1.  Click here to download the Board's printable application form (pdf), which includes detailed instructions.  Complete and mail to the Board at the address provided on the application form.

-OR-

2.  Click here to complete the online Uniform Application for Physician State Licensure through the Federation of State Medical Boards.

 

Physician Application for Special Purpose Licensure
(July 1, 2013 - June 30, 2015)
To apply for licensure as a Special Purpose Allopathic Physician (MD) in the state of Nevada, download this printable form (pdf), which includes detailed instructions.

Physician Application for Special Volunteer Medical License
To apply for licensure as a Special Volunteer Allopathic Physician (MD) in the state of Nevada, download this printable form (pdf), which includes detailed instructions.

 

Physician Application for Special Event Medical License
To apply for a Special Event Medical License (MD) in the state of Nevada, download this printable form (pdf), which includes detailed instructions.

Physician Application for Status Change (2013 - 2015)
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), which includes detailed instructions.

Physician Application for Licensure Reinstatement (2013 - 2015)
To apply for reinstatement as an Allopathic Physician (MD) in the state of Nevada, download this printable form (pdf), which includes detailed instructions.

Physician Application for Licensure Reinstatement (Authorized Facility MD License, County-Restricted MD License or Medical Research Facility-Restricted MD License) (2013 - 2015)
To apply for reinstatement of an Authorized Facility MD license, County-Restricted MD license or Medical Research Facility-Restricted MD license in the state of Nevada, download this printable form (pdf), which includes detailed instructions.

Rotating Resident Application for Limited Medical License 
To apply for licensure as a Rotating Resident in the state of Nevada, download this printable form (pdf), which includes detailed instructions.

Physician Assistant Application for Licensure
(July 1, 2013 - June 30, 2015)
To apply for licensure as a Physician Assistant in the state of Nevada, download this printable form (pdf), 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).

Physician Assistant Application for Licensure Reinstatement 
(2013 - 2015)
To apply for reinstatement as a Physician Assistant in the state of Nevada, download this printable form (pdf), which includes detailed instructions.

Practitioner of Respiratory Care Application for Licensure
(July 1, 2013 - June 30, 2015) 
To apply for licensure as a Practitioner of Respiratory Care in the state of Nevada, download this printable form (pdf), 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 775-684-1030.

Practitioner of Respiratory Care Application for Licensure Reinstatement (2013 - 2015)
To apply for reinstatement as a Practitioner of Respiratory Care in the state of Nevada, download this printable form (pdf), which includes detailed instructions. 

Perfusionist Application for Licensure
(July 1, 2013 - July 1, 2015) 

To apply for licensure as a Perfusionist in the state of Nevada, download this printable form (pdf), which includes detailed instructions.

Perfusionist Application for Licensure Reinstatement  (2013 - 2015)
To apply for reinstatement as an Perfusionist in the state of Nevada, download this printable form (pdf), which includes detailed instructions.

Authorization for Criminal Background Investigation
This form must be completed and submitted with an application for licensure as an Allopathic Physician (MD). as a Physician Assistant, as a Practitioner of Respiratory Care or as a Perfusionist in the state of Nevada. Download this printable form (pdf), complete, and submit the form with the application.

Notification of Collaboration with Advanced Practice Registered Nurse
To notify the Nevada State Board of Medical Examiners of collaboration with an Advanced Practitioner of Nursing, download this printable form (pdf).

Notice of Termination of Supervising and/or Collaborating Agreement

To notify the Nevada State Board of Medical Examiners of termination of supervision of a physician assistant or collaboration with an Advanced Practitioner of Nursing, download this printable form (pdf).

Notification of Address Change
To notify the Nevada State Board of Medical Examiners of a change of mailing address, download this printable form (interactive pdf), complete and mail to the Nevada State Board of Medical Examiners at P.O. Box 7238, Reno, NV 89510-7238.  Please note:  The address you provide will be available to the public.

Notification of Name Change
To notify the Nevada State Board of Medical Examiners of change of name, download this printable form (interactive pdf), complete and mail to the Nevada State Board of Medical Examiners at P.O. Box 7238, Reno, NV 89510-7238.

Request for Wall Certification or Wallet ID Card

You must submit a copy of your photo ID with your request in order to verify your identity to ensure your information is released only to you.

 

Letter of Verification

To request a Letter of Verification of your Nevada license, complete and mail or fax this form to the Nevada State Board of Medical Examiners with the applicable fee.

 

Credit Card Authorization Form

To pay for licensure fees or to purchase items from the Nevada State Board of Medical Examiners by credit card, complete and mail or fax this form to the Board.

 

 

 

Phone:  (775) 688-2559 
Fax: (775) 688-2321
from any other area of Nevada, call toll-free:
(888) 890-8210
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Mailing Address: P.O. Box 7238, Reno, NV 89510
Board of Medical Examiners
E-mail:
nsbme@medboard.nv.gov

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Upcoming Meetings

Next Quarterly Board Meeting:

September 5, 2014

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Agenda will be posted on or before August 29, 2014

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