Can a Nurse Practitioner Open Their Own Practice?

With a projected shortage of up to 187,130 physicians by 2037, many nurse practitioners are stepping up as essential primary care providers, especially in underserved areas.

As demand grows, so does the interest in independent practice. More NPs are asking, “Can a nurse practitioner open their own practice?”

The answer depends heavily on your state’s scope-of-practice laws.

Whether you’re planning a private practice, launching a med spa, building a telehealth platform, or managing a wellness center, understanding your practice authority is critical to staying compliant and providing safe, high-quality medical care.

Can a Nurse Practitioner Open Their Own Practice?

Yes, BUT only in certain states. Each U.S. state determines its own laws regarding nurse practitioner practice authority, which defines whether NPs can practice independently or must work under physician supervision through a collaborative practice agreement.

Some states allow full practice authority, while others impose reduced or restricted practice limits. Your ability to prescribe medications, interpret diagnostic tests, and provide direct patient care is influenced by these state board-regulated policies.

Understanding Scope-of-Practice Laws

Your scope of practice refers to the duties you’re legally allowed to perform as an advanced practice registered nurse. These include:

• Diagnosing and treating patients
• Prescribing controlled substances
• Developing treatment plans
• Managing medical services independently

A state may fall into one of three categories:

• Full Practice: NPs can operate own independent practices with full prescriptive authority and without physician oversight.
• Reduced Practice: NPs must enter into a collaborative agreement with a licensed physician for at least one element of patient care (often prescribing).
• Restricted Practice: NPs require direct oversight from a supervising physician for nearly all services.

Knowing where your state fits helps you define your business plan, legal setup, and day-to-day operations.

Nurse Practitioner Authority by State

As of 2025, 29 full practice authority states, including Washington, D.C., allow NPs to practice independently. These states empower NPs to open their own clinics, evaluate patients, and prescribe medications without physician approval.

Examples of full practice states:

• Rhode Island
• Colorado
• Arizona
• New Mexico
• Minnesota
• New Hampshire
• New York
• Oregon

The remaining states are split thus:

• 11 reduced practice authority states, which impose partial restrictions
• 10 restricted practice authority states, which require full physician supervision

Some states, like Florida, have hybrid rules. Florida requires NPs to obtain an autonomous license, which includes:

• 3,000 hours under a licensed physician’s supervision
• Proof of graduate-level coursework in diagnosis and clinical pharmacology
• No recent disciplinary actions
• An active registered nurse license

Always check with your state board of nursing to confirm the most up-to-date requirements, especially as practice laws evolve.

Key Legal & Compliance Considerations for NP-Led Clinics

Opening your own practice as a nurse practitioner means more than securing a location and treating patients. It also requires you to understand and manage several legal and regulatory responsibilities that vary by state.

State Licensing & Scope-of-Practice Laws

Before launching, verify your state’s nurse practice act and scope-of-practice rules. Even if you hold national NP certification, you must follow the laws of the state where your clinic operates, especially regarding prescriptive authority and collaborating physician agreements.

Collaborating Physician or Medical Director Agreements

In reduced or restricted practice states, you may need a formal agreement with a licensed physician to prescribe medications or provide certain services. These agreements should clearly outline roles, responsibilities, and oversight requirements to avoid compliance issues.

Malpractice & Liability Insurance

Even if your state allows independent practice, you’ll need the right professional liability insurance. Some states or partnering physicians may require your clinic to carry additional coverage, especially for services involving controlled substances, injectables, or telehealth.

Documentation & Compliance Systems

To stay audit-ready, ensure your clinic maintains accurate records for prescriptive practices, patient care protocols, and supervision agreements (if required). State boards may request proof of compliance at any time.

How Medical Director Co. Helps NPs Open Clinics

At Medical Director Co., we help nurse practitioners confidently launch and grow their own practices, no matter their state’s level of practice authority.

Whether you’re in a full, reduced, or restricted practice state, we simplify the process by connecting you with medical directors who understand your clinic’s structure, services, and compliance needs.

If your state requires a collaborating physician or medical director, we match you with qualified partners who support your clinical goals and meet all legal requirements. Our team handles the paperwork, structures the right agreements, and ensures your practice is audit-ready.

As a nurse-owned company, we understand your perspective. We’ve supported NPs across the country in opening med spas, weight loss clinics, telehealth platforms, and general primary care practices—all while helping them stay compliant and in control of their business.

Book a consultation with Medical Director Co. today and take the next step toward building your own independent NP-led practice.

Frequently Asked Questions

Can a nurse practitioner open their own practice without a physician?

Yes but only in states that grant full practice authority. In these states, NPs can operate independently, without a collaborating physician. They can evaluate patients, prescribe medications, and manage treatment plans on their own.

What are full, reduced, and restricted practice states?

• Full practice states allow NPs to work without physician oversight.
• Reduced practice states require a physician for specific tasks, like prescribing medications.
• Restricted practice states require physician supervision for most or all clinical care.

How do I know if my state allows independent NP practice?

Check with your state’s Board of Nursing or use national NP scope-of-practice maps from sources like the AANP. The regulations vary and can change with new legislation, so it’s essential to review the most up-to-date information.

What kind of insurance do I need to open my own NP practice?

You’ll need malpractice insurance and possibly medical director coverage, depending on your clinic’s services and location. If you operate in a restricted state or offer high-risk treatments, additional liability coverage may be required.

Can Medical Director Co. help if my state requires physician oversight?

Yes. We specialize in helping NPs in reduced and restricted practice states by matching them with vetted collaborating physicians or medical directors. We also handle agreements, compliance setup, and documentation so you can focus on patient care.