The credentialing process ensures that all licensed advanced practice providers meet a minimum standard for credentials, privileges and performance standards.

Credentialing applications are submitted and reviewed by the Medical staff committee and in addition by Interdisciplinary practice committee for all Nurse Practitioners.

New applicants requesting credentialing and privileges must complete the application and turn in all related documents. Incomplete applications will not be processed.

Applications must include:

  1. Completed application for Allied Health Professional Membership
  2. Signed National Practitioner Data Bank form
  3. Signed Medical Staff Bylaws/Rules and Regulation form
  4. Department documents for NP’s or PA’s listed below
  5. Documents provided by Provider: Curriculum Vitae, NP/PA licenses,DEA license, CPR (BLS, ACLS, PALS, NALS)
  1. NPI number

Hiring department must supply:

PA: position description, signed delegation of services agreement, Supervising MD responsibility for supervising PA, Proctoring plan, System of review and Letter for schedule II medications


NP: Signed position description, Proctoring plan, Standardized procedures that the provider will be working under.( VII-138, 139 or 140)