Skip to content
316-683-0178
|
info@mprcred.com
Facebook
LinkedIn
Instagram
SERVICES
PROVIDER CREDENTIALING
PROVIDER ENROLLMENT
ABOUT
OUR MISSION
OUR TEAM
REVIEWS
AWARDS
RESOURCES
DOCUMENTS
EVENTS
FAQ
BLOG
CLIENT PORTAL
CONTACT
REQUEST TO SEND APPLICATION
SERVICES
PROVIDER CREDENTIALING
PROVIDER ENROLLMENT
ABOUT
OUR MISSION
OUR TEAM
REVIEWS
AWARDS
RESOURCES
DOCUMENTS
EVENTS
FAQ
BLOG
CLIENT PORTAL
CONTACT
REQUEST TO SEND APPLICATION
SERVICES
PROVIDER CREDENTIALING
PROVIDER ENROLLMENT
ABOUT
OUR MISSION
OUR TEAM
REVIEWS
AWARDS
RESOURCES
DOCUMENTS
EVENTS
FAQ
BLOG
CLIENT PORTAL
CONTACT
REQUEST TO SEND 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
Comments
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