License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.06658-NM Certified Nurse MidWife 09/19/2001 06/09/2015 08/31/2017 ACTIVE
CTP.06658-EX2 Prescriptive Authority - Externship Extension 03/08/2002 04/08/2003 03/08/2004 LAPSED
CTP.06658-EX1 Prescriptive Authority - Externship 09/08/2006 09/08/2006 09/08/2007 INACTIVE
CTP.06658- Prescriptive Authority 09/08/2006 06/09/2015 08/31/2017 ACTIVE
PN.047894-MEDS Licensed Practical Nurse - MEDS 12/18/1974 08/01/1984 08/31/1986 LAPSED Examination
RN.203312-1 Registered Nurse-1 Certificate of Authority 09/03/1986 06/09/2015 08/31/2017 ACTIVE Examination
License and Registration Information (cont.)
CredentialSpecialty 1Certifying Org 1Certifying ExpDate 1Specialty 2Certifying Org 2Certifying ExpDate 2Specialty 3Certifying Org 3Certifying ExpDate 3
Effective February 1, 2011, the Board will require primary source verification for advanced practice nurse national recertification. For this to occur, an advanced practice nurse must request that their national certifying organization notify the Board directly of national recertification within thirty days of their recertification. The Board will no longer accept documentation of recertification directly from a COA holder.


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