Practitioner Requirements

Type of Practitioner Contract and Credentialing Required Required Documents
  • Acupuncturist [LAC]
  • Audiologist [AuD]
  • Certified Diabetic Educator (Independent*) [CDE]
  • Clinical Psychologist [PhD; PsyD]
  • Doctor of Chiropractic [DC]
  • Doctor of Optometry [OD]
  • Doctor of Podiatry [DPM]
  • Enterostomal Therapy
  • Licensed Behavioral Analyst [ABA]
  • Licensed Clinical Social Worker [LCSW]
  • Licensed Marriage & Family Therapist [LMFT]
  • Licensed Mental Health Counselor [LMHC]
  • Medical Doctor [MD]
  • Midwife - Home Birth [CNM]
  • Midwife [CNM]
  • Nurse Practitioner, Primary Care
  • Nurse Practitioner, Psychiatry
  • Occupational Therapist [OT]
  • Oral Maxillofacial Surgery (DMD)
  • Osteopathic Doctor [DO]
  • Physical Therapist [PT]
  • Registered Dietician (Independent*) [RD]
  • Speech Pathologist [SLP]
Yes
  • Completed Application
  • Malpractice Insurance
  • W-9
Type of Practitioner Contract and Credentialing Required Required Documents
  • Anesthesiologist
  • Certified Behavior Analyst Assistant
  • Certified Diabetic Educator [CDE]
  • Certified Registered Nurse Anesthetists [CRNA]
  • Emergency Room [MD]
  • Hospitalist [MD]
  • Nurse Practitioner [NP]
  • Pathologist [MD]
  • Physician Assistant [PA]
  • Registered Dietician [RD]
  • Registered Nurse First Assistan
  • Locum Tenens [MD]
No
  • Completed Application
  • Malpractice Insurance
  • W-9