DHHS Internet Website - Public Health

Physician Assistant
Applications

 Physician Assistant Application

Criminal Background Check (now required for initial licensure)

Scope of Practice Agreement

Certification of PA Licensure in Another State

Name Change Form

Duplicates/Reissue Form

Reinstatement Applications:

 Application for Physician Assistant License Reinstatement

To receive an application to reinstate a Physician Assistant License with Discipline, please contact the Department at (402) 471-2118, or email Vonda at vonda.apking@nebraska.gov.