Application Form

Credentialing Application

 

Thank you for your interest in joining Central Oregon IPA. The current version of the Oregon Practitioner Credentialing Application may be accessed online in both Word and PDF fillable formats, at http://www.oregon.gov/oha/OHPR/ACPCI/Pages/state_app.aspx

In addition to the application, please find the following COIPA-specific documents:

Once you have completed the packet, you may return it via email at credentialing@coipa.org or by fax at (541) 585-2591.