Use this application if you have never been issued an ABN provider number. A $400.00 provider fee must be submitted with the application.

Use this application if you are an active ABN provider seeking to renew provider status. A $400.00 provider fee must be submitted with the application.

This application is for lapsed providers who did not meet their renewal deadline or have retired and wish to reinstate their provider number. A $500.00 provider fee must be submitted with the application.

Notify the Alabama Board of Nursing of changes in the Program Director, Nurse Consultant, mailing/physical address, telephone number, email address or any other pertinent information.

Notify the Alabama Board of Nursing of retirement of the provider number and plan for the return of the TriCorder.