Renew Mississippi Nursing License Details

Do you need to renew your Mississippi nursing license? If so, don't worry - the process is simple! In this blog post, we'll walk you through the steps you need to take to renew your license. We'll also provide a link to the Mississippi Nurse Renewal Form, so that you can get started right away.

In the table, there is some information concerning the mississippi nurse renewal. It may be helpful to know its length, the actual time to complete the form, the blanks you'll have to fill in, and so forth.

QuestionAnswer
Form NameMississippi Nurse Renewal
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmississippi board of nursing licensure, board of nursing, ms state board of nursing, mississippi state board of nursing license renewal

Form Preview Example

MISSISSIPPI BOARD OF NURSING

713 S. Pear Orchard Rd, Suite 300

Ridgeland, MS 39157

(601) 957-6300

2014

REGISTERED NURSE RENEWAL

INSTRUCTIONS

1.Make fee payable to: Mississippi Board of Nursing

2.Renewal Fees: Active $100.00; Inactive $25.00; Advanced Practice Registered Nurse (APRN) $100.00; (additional certification $50.00 each); Controlled Substance Prescriptive Authority (CSPA) $50.00. Include your phone number and social security number and/or nursing license number on your payment. Cash will not be accepted.

3.Your current license becomes INVALID and a PENALTY WILL BE ASSESSED if not renewed by the expiration date of DECEMBER 31, 2014.

4.After the expiration date of current license, the Reinstatement fees are: Active $100.00 (plus additional fee); Inactive $25.00; Advanced Practice Registered Nurse (APRN) $100.00 (additional certification $50.00 each) and Controlled Substance Prescriptive Authority (CSPA) $50.00.

5.Name change requires a fee of $25.00, copy of marriage license, divorce decree or other legal documents indicating name change should be submitted directly to this office.

6.Advanced Practice Certification is only for the State of Mississippi.

7.If you are an APRN, complete both a RN and APRN form in order to renew your APRN certification.

8.Primary state of residence/home – is the state that is the nurse’s “declared fixed permanent and principal home for legal purposes.”

9.Multi-state licensure means you may practice as a RN pursuant to your Mississippi RN license, not in an expanded role, in any Compact state unless you have had an action limiting your privilege to practice in the other Compact state. If you change primary state of residency to another compact state you will need to obtain licensure in your new state within thirty (30) days.

10.If you or your spouse is working in a federal/military facility and Mississippi is your primary state of residence, you should include proof of Mississippi residency.

11.If you do not wish to renew your RN license, please notify the Board office in writing.

NOTE: License wallet cards will no longer be distributed. You or your employer may check licensure status by accessing

the online licensure verification at www.msbn.ms.gov.

DO NOT RETURN THIS INSTRUCTION PAGE TO THE MISSISSIPPI BOARD OF NURSING.

Revised 09/2014

MISSISSIPPI BOARD OF NURSING

713 S. Pear Orchard Rd., Suite 300

Ridgeland, MS 39157

(601) 957-6300

2014 REGISTERED NURSE RENEWAL APPLICATION

NON-REFUNDABLE FEES

Active

$100.00

Inactive

$ 25.00

Any statement made on this application which is false and known to be false by the applicant at the time of making such statement shall be deemed fraudulent and will subject the applicant to disciplinary proceedings.

LICENSE # ______________________ SS # ___________________________ PHONE # ____________________________________

NAME________________________________________________________________________________________________________

First

Middle

 

Maiden

Last

ADDRESS__________________________________________________________ EMAIL ___________________________________

P.O. Box/Street

City

State

Zip

County

My primary state of residence is: _____________________________

PLEASE CIRCLE CORRECT INFORMATION

GENDER

HIGHEST DEGREE HELD

MAJOR CLINICAL AREA

MAJOR FIELD OF EMPLOYMENT

1. Male

5.

Diploma

1.

Gerontology

1.

 

Hospital

2. Female

6.

Associate Degree Non-Nursing

2.

Obstetric/Gynecologic

2.

 

Nursing Home

 

7.

Associate Degree Nursing

3.

Medical/Surgical

3.

 

Private Duty

DATE OF BIRTH

 

8.

Baccalaureate Non-Nursing

4.

Pediatric/Child Health

4.

 

Community/Public Health

 

 

_____-_____-_____

9.

Baccalaureate Nursing

5.

Psychiatric/Mental Health

5.

 

Home Health

10. Masters Non-Nursing

6.

General Practice

6.

 

Office Nurse (Physician/Dentist/NP)

 

 

 

11. Masters Nursing Education

7.

Community/Public Health

7.

 

Federal/Military

MARITAL STATUS

12. Masters Nursing Administration

8.

Critical Care

8.

 

Industry

1. Single

13. Masters Nursing Advanced

9.

Emergency Care

9.

 

Nursing Education Program

2. Married

 

Practice

10. Dialysis

10. School/Student Health Services

 

14. Masters Nursing Other

11. Oncology

11.

Occupational Health

 

15. Doctorate Nursing Science

12. Rehabilitation

12.

Self Employed (Except Private Duty)

 

16. Doctorate Science Nursing

13. OR/RR/Anesthesia

13.

Hemodialysis

 

17. DNP Clinical

14. Quality Assurance

14.

Other(Specify)______________

 

18. DNP Non-Clinical

15. Education

 

 

 

 

19. PhD Non-Nursing

16. Neonatology

 

 

 

 

20. PhD Nursing

17. Home Health

 

 

 

 

EMPLOYMENT STATUS

18. Other(Specify)___________

 

 

 

 

 

 

 

 

 

ETHNIC INFORMATION

1.

Nursing Full-time

 

 

 

 

 

2.

Nursing Part-time

 

 

 

 

 

1. White (not of Hispanic

TYPE OF POSITION

ADVANCED PRACTICE

3.

Other Field Full-time

origin)

1.

Nursing Administrator or

REGISTERED NURSE (APRN)

4.

Other Field Part-time

2. African American

5.

Unemployed (less than

 

Assistant Administrator

ROLE

3. Native American

 

2.

Consultant

 

5 yrs)

1.

CRNA

4. Asian

 

 

3.

Supervisor or Assistant

6.

Unemployed (5 yrs or

2.

CNM

5. Hispanic

 

Supervisor

 

more)

 

3. CNS

6. Other (specify)

 

 

 

4.

Educator/Instructor

7.

Inactive

4.

CNP

____________

5.

Head Nurse/Assistant

 

EMPLOYER

 

 

 

 

 

Head Nurse

 

 

Check here if you wish to only renew

 

Name____________________

6.

General Duty or Staff

 

 

 

as a RN without renewing your

 

 

 

7.

Clinical Specialist

 

_________________________

Mississippi APRN certification.

 

 

(Masters Degree)

 

 

 

 

 

 

City ______________________

8.

Nurse Practitioner

 

 

 

 

9.

RNFA (Registered Nurse First

 

 

 

 

State _____________________

 

Assistant)

 

 

 

 

10. Other (Specify)_________

 

 

 

 

County____________________

 

 

 

 

 

 

 

 

 

 

 

 

 

Since you last held an active Mississippi license, have you been disciplined by any disciplinary licensing board or agency or convicted of a felony or misdemeanor in any court of law (excluding speeding tickets), or are any charges currently pending against

you? YES NO

If the answer to the above question is “YES”, attach a detailed explanation and certified copies of all pertinent records, including

but not limited to, any and all court and/or regulatory agency records from the applicable state or jurisdiction. Allow additional time for “YES” answers to be reviewed.

Please check here if you allow us to disclose your email address to selected third parties. YES

NO

By my signature below, I certify that the above information is correct.

Signature: _________________________________________ Date: _______________