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Out-of-State Licensee Reporting

Published on Apr 17, 2020

Updated June 11, 2020

In response to Governor Northam’s Amended Executive Orders 57, 51, and Executive Order 42, hospitals, licensed nursing facilities, and dialysis facilities in Virginia must submit to the Department of Health Professions each out-of-state health care practitioner’s name, license type, state of license, and license identification number within a reasonable time of such healthcare practitioner providing services at the applicable health care facility in the Commonwealth. 

Facilities must complete and submit the out-of-state licensed provider form and supply the following information on each provider:

  • Name of the licensed provider
  • State of licensure
  • License type
  • License number

Please access the Out-of-State Licensee Reporting Form here.

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