License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.14573-NP Certified Nurse Practitioner 06/11/2013 07/01/2015 08/31/2017 INACTIVE
CTP.14573-EX1 Prescriptive Authority - Externship 06/14/2013 06/14/2013 06/14/2014 CLOSED
CTP.14573- Prescriptive Authority 06/14/2013 07/01/2015 08/31/2017 INACTIVE
PN.119211-M-IV Licensed Practical Nurse - M-IV 08/01/2005 09/01/2006 08/31/2008 LAPSED Examination
RN.340341-1 Registered Nurse-1 Certificate of Authority 04/29/2008 07/02/2015 08/31/2017 INACTIVE Examination
License and Registration Information (cont.)
CredentialSpecialty 1Certifying Org 1Certifying ExpDate 1Specialty 2Certifying Org 2Certifying ExpDate 2Specialty 3Certifying Org 3Certifying ExpDate 3
COA.14573-NPNP - FAMILYAANP6/6/2018NP - FAMILYANCC06/27/2018
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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