Can a nurse open a medspa in Texas?
Here’s the reality: under Texas law, a nurse cannot independently own or operate the medical side of a med spa. The state’s Corporate Practice of Medicine doctrine restricts ownership of any medical practice to a licensed physician, which means nurses, NPs, PAs, and estheticians face strict legal considerations before opening a clinic.
That said, med spa owners can still participate in the business through a Management Services Organization (MSO)—a business structure that separates medical services from administrative operations. This setup helps minimize legal risks while maintaining full compliance with the Texas Medical Board.
At Medical Director Co., we make this process simple. We provide access to licensed Texas medical directors and free MSO documentation, allowing nurses to launch and operate compliant medspas without excessive legal fees or delays.
Texas Law: The Corporate Practice of Medicine
What is CPOM?
The Corporate Practice of Medicine is a Texas law that prohibits non-physicians from owning or controlling medical practices.
This matters for medspas because:
- Botox, fillers, and weight loss injections are prescription medications.
- Only physicians may own the clinical entity providing these services.
- While nurses and non-physicians can own the business side through a management services organization (MSO) agreement, they need a physician partner.
Breaking It Down by Role in Texas
Registered Nurses (RNs)
RNs cannot own the medical side of a medspa. They may inject Botox and fillers only under delegation and standing orders from a Texas medical director for RNs. Chart reviews and written protocols are also required.
Nurse Practitioners (NPs)
Texas is not a full-practice authority state.
NPs must, therefore, work under a delegation/collaborative agreement with a physician. They can co-own the MSO side, but the medical side remains under the oversight of a medical director for NPs.
Physician Assistants (PAs)
PAs must practice under a medical director for PAs. They cannot independently prescribe or own.
Estheticians & Entrepreneurs
Estheticians and entrepreneurs cannot own the clinical side of a medspa. They may own the business entity, but only through an MSO arrangement with a medical director for estheticians.
Why Out-of-State Medical Directors Don’t Work in Texas
Some companies advertise medical directors from other states. That may look good on paper, but it fails in Texas.
The TMB requires delegating physicians to be licensed in Texas.
Malpractice insurers like NSO may deny claims if agreements don’t meet Texas law.
In case of a complication, only a Texas physician can legally step in.
Case Study: In 2022, the Texas Medical Board disciplined an RN who was injecting Botox at a Dallas spa under “delegation” from a California physician. The arrangement was ruled invalid, the RN’s license was suspended, and the spa was fined and shut down.
This case shows why you need a Texas-based medical director, not just a doctor on paper.
Startup Costs for Nurses in Texas
Full Medspa Buildout
- Lease + Buildout: $80,000–$150,000
- Equipment: $40,000–$100,000
- Insurance: $3000–$7000/year
- Medical Director: $799–$2,500/month
Mobile Botox/Concierge
- Supplies: $7000–$15,000
- Medical Director: $799/month (with Medical Director Co.)
- Insurance: $3000–$7000/year
- (Optional) Room Rental: $1k–$2k/month
Where Medical Director Co. Provides Medical Directors in Texas
We place Texas-licensed medical directors in every major metro:
We also serve Plano, Frisco, Arlington, Lubbock, Corpus Christi, and Midland.
Risks of Ignoring Texas Laws
Legal Risks
Unlicensed practice can result in fines, shutdowns, and board investigations.
The TMB actively disciplines noncompliant RNs/NPs.
Insurance Risks
Malpractice carriers exclude coverage without valid delegation.
Botox complications can lead to $100,000+ lawsuits.
Financial Risks
Fines range from $5,000 to $25,000.
Cease-and-desist orders end businesses overnight.
Attorneys charge $5000–$15,000 for agreements we provide free.
Reputation Risks
Board disciplinary actions are public record.
One violation can damage your career and business permanently.
How Nurses Stay Compliant in Texas
- Partner with a Texas-licensed medical director (we can place one in your medspa within 24 hours).
- Use custom delegation + standing orders (prepared free by our legal team).
- If you’re a non-physician, set up an MSO structure.
- Carry malpractice insurance with aesthetics coverage.
- Advertise truthfully per FTC Guidelines.
Nurses Can’t Do It Alone, But Medical Director Co. Makes It Possible
In Texas, the rules are clear: Nurses cannot independently open medspas. The Texas Medical Board enforces CPOM strictly, and malpractice insurers back that up. But with the right partner, it becomes possible.
At Medical Director Co., we provide:
- $799/month Texas medical directors
- Free consulting + paperwork prep (delegation, standing orders, MSOs)
- No placement or legal prep fees
- Coverage in Dallas, Houston, Austin, San Antonio, Fort Worth, El Paso, and more
On your own, compliance is a barrier. With us, it’s a solution.
Hire a Texas medical director today and open your medspa the right way.
FAQs
Q: Can an RN open a medspa in Texas?
No. RNs can inject only under an MD delegation.
Q: Can NPs own a medspa in Texas?
Not independently. They must have a physician collaborator.
Q: Can estheticians inject Botox in Texas?
No. Only licensed medical professionals under delegation.
Q: How fast can I get a medical director in Texas?
We can place one in your medspa within 24 hours statewide (Dallas, Houston, Austin, San Antonio, Fort Worth, El Paso).
Bolton M. Harris, J.D., is a seasoned attorney with a formidable background in criminal law and a focus on healthcare law and compliance. As the in-house legal counsel at Medical Director Co., Harris brings a unique blend of prosecutorial experience and regulatory expertise to support healthcare professionals across Texas. Her career spans roles as a prosecutor in multiple counties and now as a trusted advisor on the legal intricacies of medical practice operations.
Education & Early Career
Bolton Harris completed her undergraduate studies at Southern Methodist University (SMU) in 2013. During her time at SMU, she was not only a dedicated student but also a competitive athlete on the university’s women’s swimming team. She went on to earn her Juris Doctor from Texas A&M University School of Law in 2016 and became a member of the Texas Bar that same year. Armed with a strong academic foundation and discipline honed as a student-athlete, Harris embarked on a career in criminal law immediately after law school.
Prosecutorial Experience in Texas
Bolton Harris began her legal career in public service as a criminal prosecutor. She served as an Assistant District Attorney in multiple jurisdictions, where she quickly rose through the ranks and handled a broad spectrum of cases. Some highlights of her prosecutorial career include:
- Assistant District Attorney, Dallas County, Texas: Prosecuted a high volume of criminal cases in one of the state’s busiest DA offices, gaining extensive trial experience in both misdemeanor and felony courts.
- Assistant District Attorney, Ellis County, Texas: Continued to hone her courtroom advocacy skills, known for meticulous case preparation and a tenacious pursuit of justice on behalf of the community.
- Assistant District Attorney, Navarro County, Texas: Broadened her legal expertise by handling diverse criminal matters in a smaller county, working closely with law enforcement and community leaders to uphold the law.
Through these roles, Harris built a reputation for being a tough but fair advocate. She brought numerous cases to trial and developed an in-depth understanding of the criminal justice system. This distinguished prosecutorial background laid a strong foundation for the next phase of her career in the private sector.
Healthcare Law & Compliance at Medical Director Co.
After her tenure as a prosecutor, Harris shifted her focus to healthcare law, applying her legal acumen to the medical field. She recognized that the same attention to detail and tenacity that served her in criminal law could benefit healthcare providers navigating complex regulations. Embracing this new direction, Harris became well-versed in the intricate laws governing medical practices – from licensing requirements to patient safety and privacy standards – and is passionate about helping practitioners stay compliant.
In her current role as the in-house attorney for Medical Director Co., Bolton Harris oversees all legal and compliance matters for the organization and its clients. Medical Director Co. is a nurse-owned firm that connects nurse practitioners (NPs), physician assistants (PAs), and registered nurses with qualified medical directors and collaborating physicians, offering fast placements and comprehensive compliance support for healthcare practices. Harris ensures that each of these partnerships and clinical ventures adheres to all applicable state and federal laws. She is responsible for drafting and reviewing collaborative practice agreements, advising on regulatory requirements, and providing ongoing legal counsel as clients establish and grow their clinics. Drawing on her prosecutorial eye for risk management, Harris proactively identifies potential legal issues and addresses them before they escalate, giving healthcare professionals peace of mind.
Bolton M. Harris’s multifaceted expertise – spanning high-stakes courtroom litigation to detailed healthcare compliance – makes her a formidable legal ally. Whether advocating in front of a jury or guiding a medical practice through regulatory hurdles, she remains committed to the highest standards of the legal profession. Her blend of courtroom-tested skill and healthcare law knowledge ensures that clients of Medical Director Co. receive elite-level counsel and steadfast protection in an ever-evolving legal landscape.
