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Official New Mexico Credentialing Application Template

The New Mexico Credentialing Application form is a crucial document for healthcare professionals seeking to establish their credentials with various health care organizations in New Mexico. This application collects essential information about the applicant's qualifications, practice details, and professional references. Completing this form accurately is vital for ensuring a smooth credentialing process.

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The New Mexico Credentialing Application form is an essential tool for healthcare professionals seeking to establish their practice within the state. This comprehensive document gathers vital information about the applicant, including their name, contact details, and the healthcare organization to which they are applying. It allows practitioners to specify their credentials, such as MD, DO, or RN, and includes personal details like citizenship and social security number. Applicants must also provide their practice address, effective date, and contact information, ensuring that all necessary channels for communication are open. The form asks about the applicant's specialty, languages spoken, and whether they deliver babies or wish to be credentialed as a primary care provider. Additionally, it requires references from professional peers to validate the applicant's performance. This thorough approach not only streamlines the credentialing process but also helps ensure that only qualified individuals are recognized within New Mexico's healthcare system.

Example - New Mexico Credentialing Application Form

Download New Mexico Credentialing Application PDF

Form Breakdown

Fact Name	Details
Governing Body	The New Mexico Medical Society oversees the credentialing process for healthcare practitioners in New Mexico.
Application Purpose	This form is used to apply for credentialing with various healthcare organizations, including hospitals and health systems.
Required Information	Applicants must provide personal details, including name, date of birth, social security number, and professional licenses.
Professional References	Five professional references are required, who should have the same or higher level of licensure and be familiar with the applicant's performance.
Credentialing Categories	Applicants can indicate multiple categories for which they are licensed, including MD, DO, PA, RN, and various other healthcare roles.

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