License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.08263-NS Clinical Nurse Specialist 04/14/2005 06/30/2011 08/31/2011 INACTIVE
CTP.08263-EX2 Prescriptive Authority - Externship Extension 04/21/2005 04/21/2006 04/21/2007 LAPSED
CTP.08263-EX1 Prescriptive Authority - Externship 04/21/2005 04/21/2005 04/21/2006 INACTIVE
RN.295239- Registered Nurse 06/14/2001 06/24/2013 08/31/2015 INACTIVE Examination
License and Registration Information (cont.)
CredentialSpecialty 1Certifying Org 1Certifying ExpDate 1Specialty 2Certifying Org 2Certifying ExpDate 2Specialty 3Certifying Org 3Certifying ExpDate 3
COA.08263-NS NS - ADULT PSYCHANCC7/31/2009
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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