The Mississippi Nurse Renewal form is a crucial document for registered nurses seeking to renew their licenses in the state of Mississippi. This form outlines the necessary steps, fees, and requirements for maintaining active or inactive status. Nurses are encouraged to complete the renewal process promptly to avoid penalties, ensuring their ability to practice without interruption.
To begin the renewal process, please fill out the form by clicking the button below.
The Mississippi Nurse Renewal form serves as a crucial document for registered nurses seeking to maintain their licensure in the state. This form outlines essential instructions and requirements, including the payment of renewal fees, which vary based on the nurse's status—active, inactive, or advanced practice registered nurse (APRN). For active nurses, the renewal fee is set at $100, while inactive nurses are required to pay $25. Those holding advanced practice certifications must also pay $100, with additional fees for any extra certifications. It is important to note that failure to renew by the designated expiration date, December 31, 2014, will result in the license becoming invalid, incurring penalties. The form also addresses specific scenarios such as name changes, multi-state licensure, and residency requirements, ensuring that all nurses understand their obligations and options. Furthermore, if a nurse chooses not to renew their license, they are advised to notify the Board in writing. Overall, this renewal process not only emphasizes the importance of timely submission but also incorporates various aspects that cater to the diverse needs of nursing professionals in Mississippi.
Filling out the Mississippi Nurse Renewal form can be a straightforward process, but mistakes can lead to delays or complications. One common mistake is failing to include the correct payment amount. Each renewal category has a specific fee, and it is essential to ensure that the payment reflects the appropriate amount. For example, an active nurse must pay $100.00, while an inactive nurse pays only $25.00. Omitting this detail can result in the application being returned.
Another frequent error is neglecting to provide essential personal information. Applicants must include their phone number, social security number, and nursing license number on the payment. Missing this information can cause delays in processing the renewal. Additionally, if a name change has occurred, the applicant must submit a fee of $25.00 along with the necessary legal documentation. Failing to do so can lead to confusion and further complications in the renewal process.
Some applicants may also misunderstand the requirements regarding their primary state of residence. It is crucial to accurately declare the primary state of residence, as this affects multi-state licensure and practice privileges. Misidentifying this can lead to issues when attempting to practice in other Compact states. Furthermore, if a nurse or their spouse works in a federal or military facility, proof of Mississippi residency must be provided. Ignoring this requirement could result in the renewal being delayed.
Finally, applicants sometimes overlook the importance of answering the disciplinary history question. If a nurse has been disciplined by any licensing board or agency or has faced criminal charges, this must be disclosed. Providing a detailed explanation and certified copies of relevant records is required if the answer is "YES." Neglecting to include this information can lead to serious consequences, including disciplinary proceedings. Ensuring accuracy and completeness in the application is vital for a smooth renewal process.
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
713 S. Pear Orchard Rd., Suite 300
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
Hospital
2. Female
6.
Associate Degree Non-Nursing
2.
Obstetric/Gynecologic
Nursing Home
7.
Associate Degree Nursing
3.
Medical/Surgical
Private Duty
DATE OF BIRTH
8.
Baccalaureate Non-Nursing
4.
Pediatric/Child Health
Community/Public Health
_____-_____-_____
9.
Baccalaureate Nursing
Psychiatric/Mental Health
Home Health
10. Masters Non-Nursing
General Practice
Office Nurse (Physician/Dentist/NP)
11. Masters Nursing Education
Federal/Military
MARITAL STATUS
12. Masters Nursing Administration
Critical Care
Industry
1. Single
13. Masters Nursing Advanced
Emergency Care
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
Nursing Full-time
Nursing Part-time
1. White (not of Hispanic
TYPE OF POSITION
ADVANCED PRACTICE
Other Field Full-time
origin)
Nursing Administrator or
REGISTERED NURSE (APRN)
Other Field Part-time
2. African American
Unemployed (less than
Assistant Administrator
ROLE
3. Native American
Consultant
5 yrs)
CRNA
4. Asian
Supervisor or Assistant
Unemployed (5 yrs or
CNM
5. Hispanic
Supervisor
more)
3. CNS
6. Other (specify)
Educator/Instructor
CNP
____________
Head Nurse/Assistant
EMPLOYER
Head Nurse
Check here if you wish to only renew
Name____________________
General Duty or Staff
as a RN without renewing your
Clinical Specialist
_________________________
Mississippi APRN certification.
(Masters Degree)
City ______________________
Nurse Practitioner
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: _______________
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