Skip to content
316-683-0178
|
info@mprcred.com
Facebook
LinkedIn
Instagram
YouTube
We're Hiring!
Delegation of Credentialing Form
Application Instructions
Search for:
SERVICES
PROVIDER CREDENTIALING
PROVIDER ENROLLMENT
ABOUT
AWARDS & CERTIFICATIONS
BOARD MEMBERS
CAREERS
OUR MISSION
REVIEWS
RESOURCES
DOCUMENTS
CREDENTIALING GUIDE
EVENTS
FAQ
BLOG
DID YOU KNOW
CLIENT PORTAL
CONTACT
Complete Application
Search for:
SERVICES
PROVIDER CREDENTIALING
PROVIDER ENROLLMENT
ABOUT
AWARDS & CERTIFICATIONS
BOARD MEMBERS
CAREERS
OUR MISSION
REVIEWS
RESOURCES
DOCUMENTS
CREDENTIALING GUIDE
EVENTS
FAQ
BLOG
DID YOU KNOW
CLIENT PORTAL
CONTACT
Complete Application
SERVICES
PROVIDER CREDENTIALING
PROVIDER ENROLLMENT
ABOUT
AWARDS & CERTIFICATIONS
BOARD MEMBERS
CAREERS
OUR MISSION
REVIEWS
RESOURCES
DOCUMENTS
CREDENTIALING GUIDE
EVENTS
FAQ
BLOG
DID YOU KNOW
CLIENT PORTAL
CONTACT
Complete Application
Deactivation Request Form – External
Deactivation Request Form – External
Nathan Huerter
2021-02-11T15:46:52-06:00
Deactivation Request Form (External)
Your Name
*
Email
*
Provider Name
*
Effective Date Of Deactivation
*
MM slash DD slash YYYY
Deactivation Applies to the Following Participating Health Care Facility(ies)
*
File
Max. file size: 16 MB.
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.
Let’s Get Started!
Contact us to set up a complimentary consultation or speak with one of our professionals today!
CONTACT US TODAY
Trusted by
Go to Top
