Credentialing mn 2026

1. Click ‘Get Form’ to open the credentialing mn application in the editor.
2. Begin by entering your full name as it appears on your state license in the designated fields for Last, First, Middle, and Suffix.
3. Fill out the Credentialing Contact Information section, ensuring to provide complete details including address, phone number, and email.
4. For Allied Health Professionals, complete the specific section by providing your profession/title and sponsoring physician's name if applicable.
5. Proceed to fill out Personal Data including date of birth, gender, social security number, and preferred mailing address. Ensure all information is legible.
6. Continue through each section methodically—Primary Practice Location, Additional Practice Locations, Fellowship Training—ensuring all dates are formatted correctly.
7. Complete the Disclosure Questions thoroughly. If any questions are answered affirmatively, provide detailed explanations as required.
8. Finally, review all entries for accuracy before signing and dating the Attestation Signature and Authorization sections at the end of the form.

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