One of the most common questions in the healthcare industry today is this: what states can a nurse practitioner open their own practice?
With a national physician shortage projected to reach up to 187,130 by 2037, many healthcare organizations are turning to nurse practitioners (NPs) to fill critical gaps in primary care delivery.
As a result, more NPs are exploring ways to start their own practices and deliver independent patient care without relying on physician oversight.
Yet despite growing demand, the ability for nurse practitioners to practice independently varies significantly by state due to complex and often restrictive scope-of-practice laws.
In some regions, NPs enjoy full practice authority, while others still require a collaborating physician or impose limits on prescriptive authority and clinical autonomy.
If you’re considering launching a med spa, primary care clinic, or specialty service, understanding your state’s practice environment is essential.
This guide will walk you through the different levels of practice authority, clarify how scope-of-practice regulations work, and identify which states allow nurse practitioners to treat patients independently and open their own practices.
Full Practice States: Where NPs Can Work Without Physician Oversight
Nurse practitioners in these states have full practice authority. This means they can diagnose and treat patients, prescribe controlled substances, and even open their own independent practices, all without the need for a collaborating physician.
According to the latest data from the Nurse Journal, the 30 following jurisdictions allow full NP practice authority:
- Alaska
- Arizona
- Colorado
- Connecticut
- Delaware
- Guam
- Hawaii
- Idaho
- Iowa
- Kansas
- Maine
- Maryland
- Massachusetts
- Minnesota
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Mexico
- New York
- North Dakota
- Northern Mariana Islands
- Oregon
- Rhode Island
- South Dakota
- Utah
- Vermont
- Washington
- Washington, D.C.
- Wyoming
Reduced Practice States: Where NPs Need Limited Physician Supervision
In reduced authority states, nurse practitioners can diagnose and treat patients but are required to work with a physician to prescribe medications. This limits their scope of practice, especially in controlled substance prescription and independent clinic ownership.
States with reduced NP practice authority include the following:
- Alabama
- American Samoa
- Arkansas
- Illinois
- Indiana
- Kentucky
- Louisiana
- Mississippi
- New Jersey
- Ohio
- Pennsylvania
- Puerto Rico
- U.S. Virgin Islands
- West Virginia
- Wisconsin
While some of these states may allow limited independent operation, NPs must still maintain a formal supervisory relationship, often outlined in a collaborating physician agreement.
Restricted Practice States: Where NPs Cannot Practice Independently
In restricted practice authority states, nurse practitioners are required to have physician supervision for diagnosing, treating, and prescribing. These are the most limiting environments for independent NP-led clinics and often require both on-site supervision and delegated protocols.
States with restricted NP practice authority include the following:
- California
- Florida
- Georgia
- Michigan
- Missouri
- North Carolina
- Oklahoma
- South Carolina
- Tennessee
- Texas
- Virginia
In these states, NPs cannot open their own practice without formal agreements and physician involvement. These laws often affect prescriptive authority, ability to conduct diagnostic tests, and direct patient care autonomy.
What This Means for Clinic Ownership and Medical Oversight
If you’re a nurse practitioner planning to open your own practice, reviewing your state’s scope of practice regulations is the first essential step. These laws determine whether you need physician oversight, a collaborating physician, or if you have full practice authority to operate independently.
Understanding your practice authority not only impacts daily operations and clinical autonomy but also helps you define the role of supervising physicians, manage liability exposure, and structure clear agreements for medical director services or collaborative arrangements that support regulatory compliance.
How to Stay Compliant Across State Lines
Some NPs practice telehealth or run multistate clinics. If you plan to do this, be aware that each state board sets unique practice regulations.
Even with national NP certification, you’ll still need to follow state-specific licensure, including securing prescriptive authority or working under provisional oversight agreements.
Partnering with services like Medical Director Co. can help you find a collaborating physician, manage compliance documentation, and stay audit-ready in restricted or reduced authority states.
Expand Your NP Practice Confidently with Medical Director Co.
Knowing what states nurse practitioners can open their own practice is a vital first step in building your clinic. Whether you’re in a full authority state or navigating a restricted practice environment, the right guidance can help you scale without risking compliance.
At Medical Director Co., we connect NPs with licensed medical directors and collaborating physicians who understand state law, scope of practice, and the growing role of independent healthcare providers.
Book a consultation today and learn how we can help you launch or expand your practice, no matter your state’s regulations.
Frequently Asked Questions
How does nurse practitioner authority vary by state?
Each state determines its own laws regarding nurse practitioner scope of practice.
In full practice authority states, nurse practitioners can operate their own independent practices without physician oversight. In reduced or restricted practice states, NPs may require physician supervision to prescribe medications, order diagnostic tests, or develop treatment plans.
Understanding your state’s practice regulations is key to maintaining compliance and maximizing your ability to treat patients.
Are nurse practitioners licensed at the national or state level?
All nurse practitioners must be licensed at the state level. Each state’s board of nursing regulates licensure, scope of practice, and prescriptive authority.
While some NPs hold a multistate license through the Nurse Licensure Compact, NP practice authority remains subject to individual state regulations. Maintaining licensure requires meeting educational requirements, national certification, and completing continuing education.
What is the difference between full, reduced, and restricted practice authority for NPs?
- Full practice allows NPs to evaluate patients, diagnose conditions, interpret tests, and prescribe medications independently.
- Reduced practice requires physician oversight for some elements, usually related to prescribing.
- Restricted practice requires direct physician supervision for most or all clinical tasks including diagnosing, prescribing, and treating.
Can a nurse practitioner open their own practice without a physician?
Yes, but only in states that grant full practice authority. In these states, nurse practitioners are considered qualified health professionals who can own and operate independent practices without needing physician oversight.
They can diagnose and treat patients, prescribe controlled substances, and manage care plans within the legal scope of practice defined by the state board.
Do nurse practitioners need a collaborating physician in all states?
No. In full practice authority states, nurse practitioners do not need a collaborating physician to practice.
However, in reduced and restricted practice states, a nurse practitioner must work under a collaboration or supervision agreement with a licensed physician, particularly when prescribing medications or making complex clinical decisions.
Written By:
Kiara DeWitt, BSN, RN, CPN
Kiara DeWitt is a nationally recognized Registered Nurse, Certified Pediatric Nurse (CPN), and founder of InjectCo—a rapidly expanding medical aesthetics brand with eight thriving clinic locations across Texas. With over a decade of clinical experience, Kiara began her career in pediatric neurology, serving as the Lead Clinical Educator for the Neurosurgery and Neurology Unit at Cook Children’s Pediatric Hospital, one of the most respected children’s hospitals in the country. There, she specialized in training nurses and clinicians in high-stakes neurological care, combining clinical rigor with compassionate patient advocacy.
Her transition into the aesthetics field was fueled by a passion for ethical care and a vision to transform the patient experience in cosmetic medicine. Since launching InjectCo in 2021, Kiara has grown it into a multi-location business—spanning six clinics in Dallas–Fort Worth, one in Houston, and one in Austin—anchored by her commitment to safety, education, and integrity.
As the founder of the Texas Academy of Medical Aesthetics, she also leads one of the most comprehensive hands-on training programs in the country, offering a 100+ hour injector internship where students shadow across all InjectCo clinics. Her approach has earned acclaim not only from patients but also from providers who see her as a mentor and reliable voice in a growing industry.
Kiara’s unique combination of pediatric neurological expertise, clinical leadership, and entrepreneurial success makes her a trusted authority in both medical and aesthetics circles. She is frequently sought after for insight on clinical operations, patient safety, and scaling compliant, ethics-driven practices.
