Join the Nurse Practitioner Directory

[Directory Home Page]

Personal Information
Please enter information about your practice exactly as you would like it to appear in the directory. For example if you enter T. as your middle name it will display that way. An example would be Robert T. Smithing.
Bold, red items are required. Unbold, green items are requested.
Name:       First, middle and last names. Please include a period (.) after a first or middle initial.
Credentials: These will follow your name in directory. Please do not use punctuation. Suggested format is Highest degree then licensure then other. Example: MSN ARNP FAAN. This field has 15 characters allowed.
Nick Name: If you like to use a nick name you can include it here. It will display with your formal name on directory listings. For example: Robert T. Smithing, MSN ARNP "Bob"
Year graduated: Year of graduation from NP, CNM or CRNA program. Use 4 digit year (2000).
Type of NP program:
Highest earned degree:
Gender:
Certified Specialty:
Certifying Body:
Practice Information (This information will be available for viewing on the web)
Please enter information about your practice exactly as you would like it to appear in the directory.
Bold, red items are required. Unbold, green items are requested.
Practice Name: Enter the name of your practice.
Physical Address: This is the address you give to your clients when they want to come and see you.
Postal Address: Use this only if your mailing address is different from the above address. An example would be PO Box 123
City / State / Zip:           
County / Country:     
Phone / Fax:    Please use the format 999.999.9999 X-9999
Specialty:    Select the predominant choices for your practice or add a new specialty.
New Specialty:
Email:   
 Required so directory administrator can reach you. Not required to allow any other use.
Practice URL On-line address of your practice web site.
If you do not have one then type "NONE"
 
Picture URL:
OR
 If you have a web address for a picture of you put it here. This should be a link directly to the picture itself.
Professional Status Information
The information below will not be released to consumers. It will be used to try to identify and correct duplicate entries, to resolve other administrative issues and selectively for research.
Bold, red items are required. Unbold, green items are requested.
Practice Status:  
Prior Name:  
Date of Birth: Please put in the 99/99/9999 Format  
Can you prescribe medications:  
Mail Preferences: No restrictions at this time
Do not send CE information
Do not send Employment information
Do not send NP organization information
Do not send Product information
Do not send Legislative information
Don't send any information		 Select as many choices as appropriate.
Home Information
The information below will not be released to consumers. It will be used to try to identify and correct duplicate entries, to resolve other administrative issues, selectively for research and selectively for networking with other nurse practitioners.
Bold, red items are required. Unbold, green items are requested.
Home Address:  
City/State/Zip:        
Country:  
Phone / Fax:     

Enter a User Name and Password so that you can come back and update your information at anytime.
User Name: Password:
Credit Card Information

Donate $0.00 to NP Central Using My Credit Card
Credit Card information is required to complete your profile.

Bold, red items are required. Unbold, green items are requested.
Type of Credit Card:
Name on Credit Card:
Credit Card Number:
Enter your card number without spaces.
Expiration Date: /