This form is for groups that are already part of our network.

    If you’re new and would like to be part of our network, please complete our  Join the Network Form.
    Join the Network

    Add a new provider to your credentialed group by completing the form.

    Submit one form for each new practitioner.

    Only for locations in Idaho or Montana.

    Effective November 1, 2025, we are no longer accepting provider add forms for Wyoming.

    Need credentialing for your organization? Complete this form.

    Questions or support? [email protected]

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    Start date must be today or a future date. If you have questions, please email [email protected].