The Board requires PAs to notify it when certain aspects of their status change. The most frequently used forms are listed below and may be accessed by clicking the appropriate button at right.
Intent to Practice
Physician Assistants may use the Intent to Practice form to:
Backup Supervising Physician
Licensed physician assistants are required to keep a list of all backup supervising physicians on file at all their practice locations. For your convenience, the NC Medical Board provides a form to assist with this. Click the link at right to download the form. You DO NOT need to send this form to the Board.
Physical Address: 3127 Smoketree Court, Raleigh, NC 27604
Mailing Address: PO Box 20007, Raleigh, NC 27619-0007
Telephone: (919) 326-1100 or (919) 326-1109 | Free Long Distance: (800) 253-9653 | General Fax: (919) 326-1131
The North Carolina Medical Board (NCMB) makes the information contained in this website available as a public service. Under no circumstances shall the Board, its members, officers, agents, or employees be liable for any actions taken or omissions made in reliance on any information contained in this website or for any consequences of any such reliance. Information posted in this website is not intended to constitute either medical or legal advice or opinion.
A note on the licensee information pages: NCMB attempts to ensure the accuracy of the information reported through the licensee information pages. However, because some information is received from outside sources, NCMB cannot guarantee the accuracy of all information on the licensee information pages.