Full name *

Email *

Phone number *

Credential *

National Provider Identifier (NPI) *

Enter 10 digits. We verify your NPI against the public NPPES registry.

Primary license state *

State professional license number *

We check your state license separately from your NPI.

State professional license number (optional)

Would you like to help shape Scriptura through our Clinical Council? *

Council participation is optional and separate from your platform application.

Collaborating Physician Name

Needed if your state requires a collaborating or supervising physician.

Collaborating Physician NPI

The physician's 10-digit NPI, not their state license number.

Tell us about yourself and your practice.

02 Licensing & verification