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  • Address Change Form
    Duty to notify Board of change of address: State of MS Administrative Code, Part 2610,Chapter 1; Part 2615, Chapter 1, Rule 1.10; Part 2620, Chapter 1, Rule 1.7;and Part 2625, Chapter 1, Rule 1.8 states that any physician, physician assistant, radiologist assistant, or acupuncturist who is licensed or receives a license to practice in this state and changes his or her practice location shall immediately notify the Board in writing of the change of location. Failure to notify within 30 days could result in disciplinary action.
  • Name Change Form
  • Duplicate Wallet Card Request
  • Duplicate Wallet Card Request
  • Background Check Form

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Interstate Medical Licensure Compact