In 1993, the 73rd Texas Legislature created the Physician Assistant Advisory Council as an advisory board to the Texas State Board of Medical Examiners.

In 1994, Council members were appointed and drafted rules to implement the Physician Assistant Licensing Act passed by the 73rd Legislature. In the summer of 1994, the Council began issuing licenses to physician assistants, and within six months the Council had licensed more than 1,000 physician assistants.

In 1995, the 74th Legislature made changes in the Physician Assistant Licensing Act, including changing the name of the Physician Assistant Advisory Council to the Texas State Board of Physician Assistant Examiners.

In 2015, the 84th Legislature expanded the number of board members, who are appointed by the governor for a six-year term, from nine to thirteen. Seven are practicing physician assistants, including the presiding officer. Additionally, three members are licensed physicians and three are public members.