Learn how to apply for or renew your Provisional Nursing Home Administrator license or permit.
A provisional license cannot be renewed for more than twelve total combined months per Iowa Code 155.9.
Application fee is $120. All application fees are nonrefundable.
Documentation & Questions
Documentation and questions may be submitted by email: plpublic@idph.iowa.gov
Location
Dept. of Inspections, Appeals, & Licensing
6200 Park Avenue
Suite 100
Des Moines, IA 50321
Email Address
Fee
The application fee is $120. All application fees are nonrefundable.
Proof of Licensure Duration
Attach evidence that provisional appointment will not exceed 12 calendar months in duration. If the applicant has previously served in this capacity, the following can be provided. Email the documents to plpublic@idph.iowa.gov if there are any issues attaching.
- Written employment verification signed by a facility designee.
- Written attestation signed by facility designee.