Step 1:  Download the information form by clicking here.

Step 2:  Download the list appropriate for you.  This is a list of documents we need to complete credentialing applications for you.
Provider Document List or PA or ARNP Document List

Step 3: Mail the or fax the forms to us:

Terri Lynn Davis
111 Sycamore Drive
White House, TN 37188
Phone: 800-937-4616
Fax: 270-751-0405

Note:  These documents are in Microsoft Word.  Please contact us if you need the document in another format or if you prefer they be mailed to you.