Apply for a physician assistant license

What you need for Apply for a physician assistant license

Please refer to the Full Licensure Application (DOC) for detailed instructions.

Complete applications must include the following documents:

• Completed application form, signed, dated, and notarized
• 2x2 passport style color photo
  • White or off-white background
  • Copies and printer generated photos are not acceptable
• Signed and notarized Criminal Offender Record Information (CORI) Acknowledgement Form (DOC)
• Application fee
• Official transcripts in signed, sealed envelopes from physician assistant programs/degrees with proof of a bachelor’s degree or higher
  • When requesting official transcripts, please inform each school’s registrar that the transcript must be complete and indicate the degree and date conferred in mm/dd/yyyy format
  • If transcripts have been previously submitted with an application for a Temporary Practice Certificate, they do not need to be resubmitted, if they were submitted within the past 12 months
• NCCPA documentation of certification is required. This must be sent directly from NCCPA. Email verifications are not acceptable.
  • A form to request NCCPA verification is included in the application packet

If you are registered with the Federation of State Medical Boards’ Federation Credentials Verification Service (FCVS)

An official Physician Assistant Information Profile from the FCVS may be submitted in lieu of transcripts and NCCPA documentation. If you are registered with FCVS and are using this service for your application, please inform the Board. For more information about the FCVS Profile, visit the FCVS web site.

If you are licensed in any a state or jurisdiction outside of Massachusetts

Submit verification of your licensure status, in signed, sealed envelopes, from any state or jurisdiction in which you now or have ever held any professional license or board certification. Verifications must be sent directly to the Board by the state or other jurisdictions. Note: If verifications have been previously submitted with an application for a temporary practice certificate, they do not need to be resubmitted if they were issued within the past 12 months.

If you hold, or have ever held, any professional license or certification

You must request a National Practitioner Data Bank-Healthcare Integrity and Protection Data Bank Self-Query and submit the Original report in a signed and sealed envelope with this application. To request a Self Query, please contact the National Practitioner Data Bank online or at (800) 767-6732.  Keep a copy for your records.

More info about Apply for a physician assistant license

• Application must be submitted on single-sided paper
• All requested information must be provided; failure to provide requested information may result in a delay in processing of application. We will return any incomplete applications.
  • Do not leave blanks. If you are unable to provide the requested information, attach a separate sheet with an explanation.
• Keep a copy of your completed application for your records. The Board is not able to provide copies of your application. Employers may require that you provide them with a copy.