Application Status Query

Instructions: 

Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.

Please verify the checklist information below, including your address. If your address has changed, please e-mail your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.

As of  :  12/26/2019
Application#  :  698191
Name  :  VALENTINE, ANTHONY C
Profession  :  Physician Assistant
Address  :  Ashland, WI
Application Status  :  (Permanent license issued)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
Wisconsin Statutes & Rules Examination Met
11/13/19: PASS
AD
Application Complete Met
11/12/19: Received Communicable Disease form.
------------
10/16/19: Communicable disease form (#1229) needed. You can obtain the form by using the following link: http://dsps.wi.gov/Documents/Credentialing%20Forms/Health%20Application%20Forms/fm1229.pdf You can familiarize yourself with laws here: http://docs.legis.wisconsin.gov/code/archive/2003/576b/insert/hfs145 Form can be emailed to DSPSCREDMedBdAffiliates@wi.gov or faxed to 608-251-3036
Application Fee Met
$150
Certificate of Professional Education (Form #1504) Met
12/26/19: Congratulations, your permanent license may be issued immediately; however, if your license is issued prior to 01/13/2020 it will expire 02/28/20 which will require you to pay a renewal fee ($75) to renew your license (02/28/20 is when all licenses issued for your profession expire). If you want us to issue your license prior to 01/13/2020 a written request is required. Please email DSPS at: DSPSCredMedBdAffiliates@wisconsin.gov, otherwise your license will be issued on or after 01/13/2020.
Verification of certification from the National Commission on Certification of Physician Assistants, Inc. Met
Verification of other state license(s) and/or credential(s) Met
RECEIVED
MN, OK
KC