Apply for a physician assistant temporary practice certificate

Complete applications must include the following documents:

• Completed application
• 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
• NCCPA documentation that you are registered for, and have been determined to be eligible to take, the next available administration of the physician assistant certification examination administrated by NCCPA.
  • The documentation must be sent directly from NCCPA. Email verifications are not acceptable.

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

You may submit An official Physician Assistant Information Profile from the FCVS instead 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.

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 your 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.

• If you do NOT hold and have never held any professional licenses in any other state, you do not need to submit a National Practitioner Data Bank self-query.

• 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.
• 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.

Note that the Board of Registration of Physician Assistants highly recommends that you refrain from accepting a PA position in Massachusetts until you are licensed.