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.
Question | Answer |
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Form Name | Mississippi Nurse Renewal |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | mississippi board of nursing licensure, board of nursing, ms state board of nursing, mississippi state board of nursing license renewal |
MISSISSIPPI BOARD OF NURSING
713 S. Pear Orchard Rd, Suite 300
Ridgeland, MS 39157
(601)
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.
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)
2014 REGISTERED NURSE RENEWAL APPLICATION
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 |
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Maiden |
Last |
ADDRESS__________________________________________________________ EMAIL ___________________________________ |
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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 |
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1. Male |
5. |
Diploma |
1. |
Gerontology |
1. |
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Hospital |
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2. Female |
6. |
Associate Degree |
2. |
Obstetric/Gynecologic |
2. |
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Nursing Home |
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7. |
Associate Degree Nursing |
3. |
Medical/Surgical |
3. |
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Private Duty |
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DATE OF BIRTH |
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8. |
Baccalaureate |
4. |
Pediatric/Child Health |
4. |
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Community/Public Health |
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9. |
Baccalaureate Nursing |
5. |
Psychiatric/Mental Health |
5. |
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Home Health |
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10. Masters |
6. |
General Practice |
6. |
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Office Nurse (Physician/Dentist/NP) |
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11. Masters Nursing Education |
7. |
Community/Public Health |
7. |
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Federal/Military |
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MARITAL STATUS |
12. Masters Nursing Administration |
8. |
Critical Care |
8. |
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Industry |
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1. Single |
13. Masters Nursing Advanced |
9. |
Emergency Care |
9. |
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Nursing Education Program |
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2. Married |
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Practice |
10. Dialysis |
10. School/Student Health Services |
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14. Masters Nursing Other |
11. Oncology |
11. |
Occupational Health |
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15. Doctorate Nursing Science |
12. Rehabilitation |
12. |
Self Employed (Except Private Duty) |
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16. Doctorate Science Nursing |
13. OR/RR/Anesthesia |
13. |
Hemodialysis |
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17. DNP Clinical |
14. Quality Assurance |
14. |
Other(Specify)______________ |
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18. DNP |
15. Education |
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19. PhD |
16. Neonatology |
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20. PhD Nursing |
17. Home Health |
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EMPLOYMENT STATUS |
18. Other(Specify)___________ |
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ETHNIC INFORMATION |
1. |
Nursing |
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2. |
Nursing |
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1. White (not of Hispanic |
TYPE OF POSITION |
ADVANCED PRACTICE |
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3. |
Other Field |
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origin) |
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1. |
Nursing Administrator or |
REGISTERED NURSE (APRN) |
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4. |
Other Field |
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2. African American |
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5. |
Unemployed (less than |
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Assistant Administrator |
ROLE |
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3. Native American |
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2. |
Consultant |
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5 yrs) |
1. |
CRNA |
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4. Asian |
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3. |
Supervisor or Assistant |
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6. |
Unemployed (5 yrs or |
2. |
CNM |
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5. Hispanic |
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Supervisor |
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more) |
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3. CNS |
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6. Other (specify) |
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4. |
Educator/Instructor |
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7. |
Inactive |
4. |
CNP |
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____________ |
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5. |
Head Nurse/Assistant |
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EMPLOYER |
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Head Nurse |
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Check here if you wish to only renew |
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Name____________________ |
6. |
General Duty or Staff |
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as a RN without renewing your |
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7. |
Clinical Specialist |
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_________________________ |
Mississippi APRN certification. |
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(Masters Degree) |
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City ______________________ |
8. |
Nurse Practitioner |
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9. |
RNFA (Registered Nurse First |
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State _____________________ |
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Assistant) |
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10. Other (Specify)_________ |
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County____________________ |
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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: _______________