Provider Nomination Form

Owensboro Community Health Network is committed to continuously improving the quality of patient care and serving the community.

A Provider listing is available here or you can call 270-691-8020 to determine if a provider is participating with OCHN. If a provider is not listed and you would like to have him/her added to our network, please complete the below form.We will then contact the provider to discuss joining the OCHN network.

A nomination does not guarantee participation in the OCHN network. Providers must go through a credentialing process which can take up to 30 to 60 days from the date a provider application is received from the provider. If you prefer, you may download a copy of the form and mail in.
Provider Name: (MD,DO, etc):
Group Name:
Office Address:
City: ST: ZIP:
Phone:
Provider Specialty: