Uniform Credentialing Application

Note:  The files on this page have been converted to PDF files. You will need the Adobe™ Acrobat ™ Reader to view the files.  A short-cut is provided on the left in the blue column.

The completed application may be submitted to hospitals, ambulatory surgery centers, managed care organizations, and other entities requiring credentials verification.   

PLEASE DO NOT SEND THE APPLICATION TO THE
OKLAHOMA STATE DEPARTMENT OF HEALTH

    Law Excerpt, 63-1-106.2 (12K PDF)

    Rule Excerpt, 310:2-15 (10K PDF)

Uniform Credentialing Application (PDF)

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Mailing Address:
Oklahoma State Department of Health
Health Resources Development Services
Managed Care Systems
123 Robert S. Kerr. Ave., Suite 1702
Oklahoma City, OK 73102-6406

Physical Address:
Oklahoma State Department of Health
Health Resources Development Services
123 Robert S. Kerr Ave.
Oklahoma City, OK

Phone: (405) 426-8175
Fax: (405) 900-7571
Email: healthresources@health.ok.gov