SAMPLE for the demonstration: a fictional certificate, not a real document. In real use this is the scan or PDF the coordinator attaches.

Payer enrollment

Ridgeline Health Partners credential file

Issued toNadia Brooks, APRN, FNP
CredentialPayer enrollment (MCD)
NumberMCD-ENR-DEMO-4044
Issued byState Medicaid
Valid fromNov 25, 2022
Valid throughNov 25, 2027

Fictional provider and number. Close this tab to return to the Credential Tracker.