Request for Inactive License Status You must have an active license to place your license inactive. Only the licensee should change information on this site. By entering information on this site, you are representing that you are the person whose information is being changed. By submitting this form, you are requesting your license to be placed on inactive status. While on inactive status, you cannot practice nursing nor use your nurse title. If you plan to resume nursing practice, you must follow the procedures to reinstate your nursing license. The form to do so can be found at https://pr.mo.gov/nursing.asp under Licensure and then Form to Renew Expired Missouri License.

Name as it appears on your license:

Primary Address: (Physical address required, PO Boxes are not acceptable)

Mailing Address: (Only required if your mailing address is different that your primary address)

Code

Please type the numbers displayed above in the box below.