Passing the PANCE doesn't make you a PA. Your state does. Here's how to find your board, what it decides, and what the whole thing actually costs.
There's a strange gap after graduation that nobody really warns you about.
You've finished the program. You've passed the boards. You are, on paper, a certified physician assistant. And you still can't legally see a single patient.
Between you and your first shift sit four separate credentials, issued by four different bodies, on four different timelines. Miss one and you sit at home while your start date slides.
That is the system today. It is also the system that is about to change, and I have put what the PA Licensure Compact will mean further down, because it is the most important thing happening in PA licensing right now.
The four things standing between you and your first patient
- National certification — you pass the PANCE and the NCCPA certifies you. That's the letters after your name. It is not a license.
- A state license — issued by the state where you'll practice. This is the one that makes it legal. It's also the slowest, and the one this article is about.
- An NPI number — your National Provider Identifier, free from CMS, and the thing that lets anyone bill for your work.
- A DEA registration — only if you'll prescribe controlled substances. Federal, and it costs real money.
Certification is national and portable. Licensure is not. Move across a state line, and you start the second one over again, at a different board, with different rules and a different check.
Find your state licensing board
Every jurisdiction does this differently, and the first job is simply knowing who to talk to. In some states, a dedicated PA board issues your license. In most, it's the medical board. In a few, it's a health department with no PA board at all. In three, there are separate MD and DO boards, and you have to pick the right one.
Tap your state below and you'll get the board that actually issues your license, plus anything unusual about how that state runs things.
Find your state licensing board
Every US jurisdiction, with the board that actually issues your PA license. Tap a state, or search.
| Jurisdiction | Licensing board | Notes |
|---|
Board links opened and checked July 2026. Your state board is the only authority on its own rules — always confirm there before you pay a fee or count on a requirement.
What your board actually decides
Your board is the only authority on your board’s rules, and those rules move between legislative sessions — sometimes quietly, and rarely with a press release. That is exactly why the tool above hands you the board itself instead of asking you to trust a number on a page.
Here is what to look for once you get there:
- Do they require current NCCPA certification, or just that you passed the PANCE once? This is the big one, and states genuinely differ. Some want you certified for life. Some only care that you passed.
- What does renewal actually require — CME hours, current certification, or both? And how many hours, over what cycle?
- Is there a separate prescriptive authority step? In several states, your license and your right to prescribe are two different applications.
- What happens if you've been out of clinical practice? Most boards have re-entry requirements after an extended gap, and they're rarely on the main page.
- Do they need a supervising or collaborating physician named at application? If so, you can't finish the form until you have a job.
What this is going to cost you
More than people expect, and it lands all at once, usually in the months when you're least able to absorb it.
There are four buckets:
- Your state application and license fees. These vary enormously — low three figures in some states, several hundred dollars in others, often split into an application fee and a separate license fee. Your board publishes its own schedule; that's the only number worth trusting.
- DEA registration, if you'll prescribe controlled substances. DEA's fee rule set the practitioner registration at $888 for a three-year term, effective 1 October 2020. Check DEA for the current figure before you budget — but assume it is the single biggest line.
- NCCPA certification maintenance, on its own cycle, separate from everything else.
- The invisible ones — verification and transcript fees, fingerprinting and background checks, notarisation, and in some states a jurisprudence exam.
Ask your employer to cover this. Plenty do, and it is a completely normal thing to raise. Raise it before you sign, though — it is much harder to negotiate a licensing stipend in month three than it is in the offer conversation. Our PA Contract Check will tell you whether an offer covers it, and the hourly rate calculator will tell you what the package is really worth once these costs come out.
Start earlier than you think you need to
The whole sequence typically runs two to three months, and almost none of that is in your control. Boards wait on verifications from your program, from the NCCPA, from other states you've held a license in. Background checks take what they take.
And the order matters. Your DEA registration is tied to a state license and a practice address, so you can't start it until the license lands. Which means a slow license quietly delays your prescribing too.
Start the paperwork the moment you're eligible. Not after graduation. Not after the PANCE.
Renewal, and what happens if you let it slip
Once you're licensed, this becomes a recurring obligation you cannot afford to forget.
Most boards renew on a one- or two-year cycle and mail a notice to your address of record roughly ten weeks out. You are responsible for renewing whether or not that notice reaches you. Boards do not accept "it went to my old apartment" as a reason.
Practicing on an expired license is not a technicality. It is practicing without a license, and it is the kind of thing that follows you onto every future application and credentialing file you ever fill in.
There is usually no grace period. Miss the date, and you're delinquent immediately. Stay delinquent long enough — five years in many states — and the license is canceled outright. At that point you don't pay a late fee, you apply again from scratch and meet whatever the current requirements are, not the ones that applied when you first qualified.
Put the renewal date in your calendar the day you get licensed, with a reminder three months out. Update your address of record every time you move.
The PA Licensure Compact is the biggest change coming to any of this
Everything above describes the system as it works today: one board, one state, one application, and you start over from scratch the moment you cross a state line.
That system is being rebuilt right now, and I do not think most PAs appreciate how big a deal it is.
The PA Licensure Compact is an interstate agreement. Hold one license in a member state, and you can get the authority to practice in every other member state through a single application instead of a full separate licensure process in each one. That authorization is called a compact privilege, and it carries the same legal weight as a state-issued license.
Where it stands
- Twenty-nine states have enacted it — more than half the country: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Iowa, Kansas, Maine, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Rhode Island, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia and Wisconsin.
- Michigan made twenty-nine, and was the fifth state to join in under a month. The AAPA calls it the fastest multi-state passage of a PA model bill in the history of the profession.
- The compact activated in April 2024, when Virginia became the seventh state. The Compact Commission has met since that fall, has finalized its rules on who is eligible and how you apply, and has picked a vendor to build the data system that will connect the state boards.
- Bills were still live in Massachusetts and Pennsylvania during the 2026 session.
The part people keep getting wrong
Your state enacting the compact does not mean you can use it yet. I want to be blunt about that, because I keep seeing PAs assume otherwise and make plans around it.
Passing the law is one step. The Commission still has to finish its remaining rules, stand up the data system, and onboard each state board. The Compact Commission anticipates PAs being able to apply for privileges in early to mid-2027. Until that happens, a compact state licenses you exactly the way it always has, and everything else on this page still applies.
What you will need to qualify
- An unrestricted license in a member state. That becomes your qualifying license, and you keep it — the compact adds to it, it does not replace it.
- Graduation from an ARC-PA accredited program.
- Current NCCPA certification, maintained.
- No felony or misdemeanor convictions, and no controlled substance registration that has been suspended or revoked.
- No limitations or restrictions on any license or privilege you already hold.
The privilege fee has not been set. That rule is still with the Commission’s finance committee.
Two things it does not do
When you practice in another state on a compact privilege, you practice under that state’s laws, not your home state’s. Scope, supervision or collaboration requirements, prescribing rules — all of it belongs to the state the patient is in. The compact speeds up the paperwork. It does not let you export your home state’s practice environment.
It also ties your record together. If your qualifying license is disciplined, you lose your privileges in every remote state until the restriction is lifted and two years have passed. A remote state can also act against your privilege inside its own borders.
Why this one matters
If you do telemedicine, work locums, live near a state line, cover for a health system that spans several states, or serve a rural region that borders two or three of them, this is the difference between one application and five. For a profession whose whole argument is that we can get clinicians to where patients actually are, that is enormous.
Watch the PA Compact Commission news page for quarterly updates, and the AAPA compact page for the current state count. If your state has not joined yet, your state chapter is who moves that bill.
Where else the profession is moving
Beyond the compact, four shifts are worth having on your radar:
- The title is changing, slowly, state by state. Six states have "physician associate" in statute — Oregon was first in 2024, then Maine and New Hampshire, then Iowa, Delaware and Alaska. Kansas and Wisconsin recognize the title without a full statutory change, and Kansas's does not take effect until 1 January 2027. Your certification is unaffected: the exam is still the PANCE and the credential is still PA-C.
- Optimal Team Practice keeps expanding. The AAPA lists ten states that have removed the legal requirement for a specific supervising-physician agreement. What that means day to day still depends heavily on your setting and your employer.
- Genuinely standalone PA boards remain rare. You'll see "nine states have their own PA board" repeated a lot. In practice only five — Arizona, California, Iowa, Massachusetts and Tennessee — have a board that independently licenses PAs. Elsewhere a PA committee or council may advise, but the medical board signs.
- Recertification has changed shape. Most PAs now maintain certification through the longitudinal PANRE-LA rather than a single sitting. More on that in the PANCE and PANRE pass rate numbers.
Where to go next
- Your state PA chapter — the people who actually track the legislation in your state, and usually the fastest way to find out what's coming.
- Practicing PA resources — contracts, salary data, CME and the rest of the working-PA toolkit.
- Where to actually find the job that all this paperwork is for.
None of this is the interesting part of being a PA. It is just the toll booth between school and the work. Get it started early, keep the receipts, and put the renewal date somewhere you'll actually see it.
Thanks for reading — and congratulations, genuinely. This part means you're nearly there.
— Stephen Pasquini, PA-C
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Has anyone applied for a NJ license? Who do the verification employment forms need to be filled out by? Human Resources?
I am a PA in Virginia and will be traveling to California to be with my family for an extended period. My father passed away last month from COVID and I was unable to be there while he was ill or to attend his funeral due to restrictions. However, I am now vaccinated as is my mother, who has Parkinson’s, and I want to go help her. While in California, I am planning on continuing with Telepsych for my Virginia patients. I have already applied for my CA license, but would like to know if my supervising physician in VA can continue to supervise me while I am in CA. I can’t seem to find any information about supervision other than the supervisor needs to be available electronically or in person while the PA is seeing patients, which will not be an issue.
Thank you,
Kelly Lohmann, PA-C
I need to renew my license but now they required background check in Texas. If the process is delayed, can you still renew license in time?
Hi! Great post.
I want to get the ball rolling on getting a state license – I graduate in 2 months. Do I have to wait until I at least graduate to apply? Some states have a permit you can apply for before PANCE, but it seems like I still need to graduate first. Some states have fingerprinting processes that take weeks to mail out, but usually after an application is submitted (after one has graduated). I was wondering if there was a way to get the ball rolling on this before graduating, or if I will just have to wait it out.
Hi Thea, it likely depends on the State but it would be worth contacting the State chapter and licensing board to see what your options are. It never hurts to get an early start or at least know what all your options are!
Warmly,
Stephen Pasquini PA-C
http://www.smartypance.com
http://www.thepalife.com
Hi! I just passed the PANCE and started looking into licensing. I do not have a job currently lined up, so is it still possible to obtain licensure without having a supervising physician number to use in the application? Can this be left blank and updated at a later time? Thanks!
Hi. I believe the answer is yes. I know when I went through the process 15 years ago I also did not have a supervising physician although we used snail mail at the time. You may want to contact the licensing board for clarification just in case.
P.S. Congrats on passing your PANCE!!
Stephen
If I am unsure what state I plan to practice in, would it be recommended to apply to multiple licenses. Is there a limit? With COVID there are less opportunities right now and I am finding some states have more openings than others. Thank you.
Hello,
I am a new grad looking to obtain a license in Texas as I have just recently moved to Austin. I am wondering if anyone has any insight on how to obtain this as a new grad… I looked on the Texas Medical Board website and it says “Have practiced at least 20 hours a week for 40 weeks in one of the two years preceding application” … Does anyone know how strict they are with this?
This is fascinating Dillon. At first, I thought you must have read the requirement wrong, but upon further investigation, I see that you are right, they do have a checklist requirement of “at least 20 hours a week for 40 weeks in one of the two years preceding application.”
http://www.tmb.state.tx.us/page/pa-eligibility-for-licensure
I would suggest contacting the state board directly. This just doesn’t make sense. When you get an answer I would love it if you came back and updated us with their response.
Stephen
Hi, I wish to know if my PA license from Puerto Rico is valid in Florida
Hi Brian, it would be best to contact the Florida licensing board directly. Here is a map of all the AAPA state constituent chapters: https://www.thepalife.com/state-chapters-map/
In these testing times, is there any state offering PA license to an IMG who is ECFMG certified MD?
Thanks
Stephen, I have purchased info from you in the past (I.E. cover letter cv and especially the follow up letter examples / do’s don’ts). It’s appreciated.
Question however has likely been answered elsewhere so forgive me. Been a PA-C for over 20 years and practiced at all times and am now – with my Pennsylvania license (which includes 2 years in CO but still used Pennsylvania credential as it was Govt facility). I once was looking at job in MD and was made an offer and obtained a MD license also. I received MD license but never ever practiced there and have no intention to after 20 years and the “R” word is creeping up for next life. I have always renewed MD license and must now….Why would I want to keep renewing if “R”etirement is in sight and zero aspiration to relocate? Any reason to keep other than saying “Well, you never know if you will end up taking a job in MD”. It’s not in question and if that situation, then I retire today.
Hello, I am undecided as to which state I would like my first PA job to be in, is it possible to apply for 2 pa licenses in different states? And if it is, can I just start the one PA license and not pay for the active license once I decide?
As far as applying for two licenses in different states, the answer is yes, you can. As far as payment is concerned, I believe (although I am not 100% sure) you have to apply and pay upfront. There are also several requirements like live scans (which are required in my home state of CA), which will require your presence. The best thing to do is to look closely at the requirements of each state. You may be able to delay payment and still get the process rolling, which I know is what you are looking to do and would make a lot of sense. You will have to come back and let me know what you find. It has been a long time since I have applied for State licensing, so I know things have changed.
Warmly,
Stephen Pasquini PA-C
http://www.smartypance.com
http://www.thepalife.com
What is it like to transfer between states as a PA? In regards to my license it usually easy to move to another state and find a job quickly?
Hi Will, it’s not too difficult, when I came to CA years ago after having completed my PA education on the East Coast it took about 30-45 days to obtain my CA State license. I wish I could remember all the details. There was some paperwork involved and probably a fee (or two) but you can complete this at the same time you are having your credentialing paperwork completed at your place of employment which is also a bit of a process. There is no examination, just a few hoops to jump through.
Stephen
New PA grad here and would love some guidance! Are there any specific documents I need to send to the state licensing board, besides releasing my NCCPA certification? How do they know I graduated from an accredited PA program? Or do I have to ask my school to release that info?
Hi Eliza, when you graduate you should be provided with guidance on the next steps you need to take. If you are not working in the same state as your school and you are still unsure of what documentation you need or where you need to send it just contact your state medical licensing board directly they will be able to guide you. I did this so many years ago, I can’t even remember what I submitted. I know it took a bit of time though to get everything processed. Nowadays I just send them money. As long as they get that they seem pretty happy! 🙂 So does the AAPA, NCCPA, DEA, etc. etc. that love to bleed us poor PAs dry!! Not that I am complaining or anything 🙂
Stephen
I heard that a PA working at a rural health clinic in texas can get their DEA license for free. Is this true or are there no exceptions to the $731 fee every 3 years?
This sounds good to me. I think it’s time to move to rural Texas!! 🙂
Stephen
You didn’t listed required NCCPA’s or come for Guam and Puerto Rico. I have been a PA for 15 years my license is current but I did not took panre. Do you think I’ll be able get a job in Hawaii. I been practicing in California.
Hi Harmandeep, It’s a good question and I’m sorry I don’t have the answer. You may want to contact the State of Hawaii licensing board or the NCCPA directly for more information. Here is an interactive map of all the state chapters: https://www.thepalife.com/state-chapters-map/
Stephen
Hi everyone,
I just graduated a couple weeks ago, and just found out I passed the PANCE two days ago! PA-C!
Anyway, I’m having a hard time figuring out how far I can get with licensing and everything without already having a job lined up. I’m applying for jobs in KY and in MI (I live in KY and would prefer to stay but my wife’s family lives in MI).
Can I apply for an NPI number without a business address?
Can I apply for a MI or KY license without a supervising physician lined up?
I’ve tried to contact a woman in the KY PA license office several times and have not had any luck.
Thanks in advance for any help you guys are able to provide
Hey Stephen, I’m a new grad getting ready to graduate this August from a school in Florida. I’m originally from Texas but they don’t allow temporary licensure or for PA’s to work without a license (as stated in this article) but Florida does as long as you’re scheduled/eligible to take your PANCE, and are in the process of obtaining your licence. Do you think many jobs will not consider you if you can’t work immediately?
Hi Emmanuel, yes, absolutely. I know of many PAs who have accepted jobs in this situation with the start date set for a month or so after they take their PANCE. Often times, employers will use this as an orientation period.
Stephen
While waiting for license what can you do for your employer? I work in a traveling geriatrics position and am waiting for license.
We have a PA working for us now who is in a similar situation, although in her case she is a new graduate. We have her shadowing and seeing patients with supervision under our credentials. She is learning the EMR and will be ready to run when her credentials come through in the coming weeks.
Is she getting or allowed to get paid? or hired on as a medical assistant/etc. so she can get paid? I might be doing something similar as I wait for my license, and I am curious how to do this in a way to make sure there will be no chance for repercussions. Thank you!
The links to Virginia on interactive map and the list below it point to the Virgin Islands; otherwise an informative article.
Great article. I’m dealing with many of these issues as well..