Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin with the applicant information section, ensuring to enter your last name, first name, and any middle or maiden names as required. Don't forget to include your date of birth and Social Security number, and provide a clear, current home address.
3. Complete the credentialing entity name field, specifying which organization you are recredentialing with.
4. For office practice information, indicate if your practice has changed since the last credentialing date. If it has, fill in the necessary details about your primary and any additional offices.
5. In the medical/professional education section, provide details of your medical school, including its name, your degree, and the dates of attendance.
6. Proceed to the state licenses section and list all licenses currently held. Be sure to attach copies of these licenses as instructed.
7. Fill out the certifications/registrations section, indicating your current certifications and including copies where required.
8. In the professional liability insurance section, detail your current coverage and provide copies of the insurance face sheets.
9. Carefully complete the practice disclosure information, acknowledging any investigations or past disciplinary actions that may apply.
10. Review your entire application for accuracy, ensuring all required attachments are included. Finally, you can save your changes, download, print, or share the completed form as necessary.

Complete the WV Recredentialing Form online today to ensure your credentials are up to date.