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Often yes, but practice authority and ownership are two different questions. Practice authority asks whether a nurse practitioner (NP) can diagnose, treat, and prescribe without a physician agreement. Ownership asks whether an NP or physician assistant (PA) can hold the equity of an entity that delivers care, and especially an entity that employs physicians. The American Association of Nurse Practitioners (AANP) sorts states into full, reduced, and restricted practice; our compiled data, based on those classifications, currently shows 28 jurisdictions, including DC, as full practice, 12 as reduced, and 11 as restricted. Check AANP's current map before relying on any count. Separately, our site classifies each state's corporate practice of medicine (CPOM) posture. An NP in a full practice state can usually own a practice that delivers NP care. An NP who wants to employ physicians, or a PA in most states, often needs a physician-owned professional corporation (PC) or a collaborating physician in the structure.
This is general information, not legal advice. Confirm the current rules with a healthcare attorney licensed in each state where you operate. Last reviewed October 2026. State rules change often; statute and case references are summaries, not quotations.
Key takeaways
- AANP classifies NP practice environments as full, reduced, or restricted; our compiled data currently shows 28 full, 12 reduced, and 11 restricted jurisdictions including DC, but verify against AANP's current map.
- Full practice authority lets an NP practice without a physician agreement, but it does not by itself let an NP-owned entity employ physicians or practice medicine in a strong CPOM state.
- PAs in most states still practice under a supervision or collaboration relationship with a physician, which shapes how a PA-founded business can be structured.
- Med spas are medical practices for CPOM purposes when they perform injectables, lasers, or prescription treatments, so NP ownership rules apply directly.
- For telehealth, both practice authority and CPOM are determined by the state where the patient is located, so a national NP-led brand has to meet the strictest state it serves.
What is the difference between practice authority and ownership?
Practice authority is a scope-of-practice rule set by the state nursing board and legislature. It decides whether the NP needs a collaborative or supervisory agreement with a physician to provide care.
Ownership is governed by different law: CPOM doctrine, professional corporation and professional LLC statutes, clinic licensure rules, and fee-splitting statutes. A state can grant NPs full practice authority and still restrict who may own an entity that employs physicians. Founders who conflate the two end up with an entity that is fine for NP services and unlawful the day it hires an MD.
What do AANP's full, reduced, and restricted categories mean?
AANP sorts states into three practice environments. In broad terms (this is our paraphrase; see AANP for its exact definitions):
- Full practice. NPs can generally evaluate, diagnose, treat, and prescribe under the authority of the state board of nursing, without a required physician agreement.
- Reduced practice. State law limits some part of NP practice, typically by requiring a collaborative agreement with another health provider.
- Restricted practice. State law generally requires supervision or a similar oversight relationship with another health provider for the NP to provide patient care.
Many states also impose transition-to-practice hours before full authority applies, so a newly licensed NP may still need a collaborative agreement in a full practice state. Several restricted states carve out partial independence. Florida, for example, allows certain experienced APRNs to register for autonomous practice in primary care, even though our AANP-based data lists Florida as restricted. Confirm the current eligibility rules with Florida counsel.
How does CPOM interact with NP and PA ownership?
The combinations matter more than either classification alone.
| NP practice authority | Site CPOM classification | Typical result for an NP founder |
|---|---|---|
| Full | None | NP can usually own the practice; employing physicians may also be possible, subject to entity and clinic rules |
| Full | Strong | NP can own an NP practice, but a physician-owned PC is generally needed to employ physicians or offer physician services |
| Reduced or restricted | None | Ownership may be open, but the NP still needs a collaborating or supervising physician to practice |
| Reduced or restricted | Strong | Both constraints apply: a collaborating physician to practice, and a physician-owned PC for physician services |
Six jurisdictions in our data pair full NP practice with strong CPOM: Colorado, Massachusetts, Nevada, New York, North Dakota, and Oregon. Four pair restricted NP practice with no CPOM doctrine on our classification: Florida, Missouri, Oklahoma, and Virginia. Those ten states are where founders most often misread the rules.
Oregon deserves special attention. It gives NPs full practice authority, but Oregon's SB 951 (2025 session) addresses limits on management services organizations that serve professional medical entities; confirm its final form and effective dates with Oregon counsel. An NP-led brand with an MSO behind it should read our Oregon CPOM guide. California runs the other way: our AANP-based data lists it as restricted, though California law (AB 890) created a pathway toward NP practice without standardized procedures, and California's SB 351 (2025 session) addresses CPOM limits on private equity and hedge fund investors; check its current status before relying on it. See our California CPOM guide.
Where do physician assistants fit?
PAs face a different starting point. In most states, PA practice still requires a defined relationship with a physician, labeled supervision, collaboration, or a practice agreement. The national PA professional association has promoted "optimal team practice," which aims to replace mandatory supervision with collaboration determined at the practice level, and a growing number of states have moved in that direction. The specifics vary widely, including hour thresholds before a PA can practice under looser collaboration rules.
For ownership, PA rules tend to be stricter than NP rules. Some professional entity statutes allow PAs to hold minority interests alongside physicians; others do not address PAs at all. A PA founder should assume a physician partner or a physician-owned PC is part of the structure unless state counsel confirms otherwise.
What does this mean for med spas?
Botulinum toxin, dermal fillers, prescription skin treatments, many laser procedures, and weight-management prescribing are medical services in most states. A med spa offering them is a medical practice for CPOM purposes, whatever it calls itself.
- In a full practice state with no CPOM doctrine, an NP can often own the med spa and provide the treatments directly.
- In a strong CPOM state, a non-physician owner, including an NP, typically needs a physician-owned PC to hold the medical side, with the spa business running as an MSO.
- In reduced or restricted states, the NP needs a collaborating or supervising physician, and the spa's medical director role must be real.
Our existing guide to the medical director for a med spa covers that role in depth.
What does this mean for an NP-led telehealth brand?
Telehealth adds geography. The patient's location decides which state's practice authority, CPOM rules, and licensure apply. An NP licensed in a full practice state who treats a patient located in a restricted state needs a license there and must meet that state's collaboration rules. Our telehealth licensing by state guide covers the licensure side.
For ownership, a national brand founded by an NP tends to land in one of three structures:
- NP-owned practice in full practice states only, with patients in other states excluded.
- NP-owned practice plus collaborating physicians in reduced and restricted states, with each collaboration agreement meeting the state's requirements.
- Friendly PC-MSO structure, where the NP founder owns the MSO and a physician owns the PC that employs both physicians and NPs. This is usually the only structure that scales to all 50 states with physician services included. See the friendly PC-MSO model explainer, the management services agreement guide, and how MSO management fees must be set.
The 50-state corporate practice of medicine guide explains each state's CPOM classification. Our existing article on the collaborating physician role covers what a collaborating physician actually does day to day.
State-by-state: NP practice authority and CPOM
NP practice authority as compiled in our data from AANP's State Practice Environment classifications; CPOM classification per MyOrbitHealth's 50-state guide. Last compiled October 2026. Verify each row against AANP's current map and with state counsel before relying on it.
| State | NP practice authority (AANP) | Site CPOM classification |
|---|---|---|
| Alabama | Reduced | None |
| Alaska | Full | None |
| Arizona | Full | Moderate |
| Arkansas | Reduced | Moderate |
| California | Restricted | Strong |
| Colorado | Full | Strong |
| Connecticut | Full | Moderate |
| Delaware | Full | None |
| District of Columbia | Full | Limited or unsettled |
| Florida | Restricted | None (Health Care Clinic Act licensure applies to non-physician-owned clinics) |
| Georgia | Restricted | Limited or unsettled |
| Hawaii | Full | Limited or unsettled |
| Idaho | Full | Limited or unsettled |
| Illinois | Reduced | Strong |
| Indiana | Reduced | Moderate |
| Iowa | Full | Moderate |
| Kansas | Full | Moderate |
| Kentucky | Reduced | Limited or unsettled |
| Louisiana | Reduced | Limited or unsettled |
| Maine | Full | None |
| Maryland | Full | Moderate |
| Massachusetts | Full | Strong |
| Michigan | Restricted | Strong |
| Minnesota | Full | Moderate |
| Mississippi | Reduced | Limited or unsettled |
| Missouri | Restricted | None |
| Montana | Full | Limited or unsettled |
| Nebraska | Full | None |
| Nevada | Full | Strong |
| New Hampshire | Full | None |
| New Jersey | Reduced | Strong |
| New Mexico | Full | None |
| New York | Full | Strong |
| North Carolina | Restricted | Strong |
| North Dakota | Full | Strong |
| Ohio | Reduced | Limited or unsettled |
| Oklahoma | Restricted | None |
| Oregon | Full | Strong |
| Pennsylvania | Reduced | Moderate |
| Rhode Island | Full | Moderate |
| South Carolina | Restricted | Moderate |
| South Dakota | Full | Moderate |
| Tennessee | Restricted | Moderate |
| Texas | Restricted | Strong |
| Utah | Full | None |
| Vermont | Full | None |
| Virginia | Restricted | None |
| Washington | Full | Moderate |
| West Virginia | Reduced | Moderate |
| Wisconsin | Reduced | Moderate |
| Wyoming | Full | None |
Frequently asked questions
Can a nurse practitioner own a medical practice?
In many states, yes, especially in states with full practice authority and no strong CPOM doctrine. Ownership of an entity that employs physicians or offers physician services is a separate question, and in strong CPOM states it generally requires a physician-owned professional corporation.
Can a nurse practitioner own a med spa?
Often yes in full practice states without CPOM restrictions. In strong CPOM states, or where the NP needs a collaborating or supervising physician, the med spa usually needs a physician-owned PC or a real medical director relationship, because injectables and lasers are medical services.
Can a physician assistant own a medical practice?
PA ownership is more limited than NP ownership in most states. Because PAs generally practice under a supervision or collaboration relationship with a physician, and many professional entity statutes reserve ownership for physicians, a PA founder usually needs a physician partner or a friendly PC structure.
Does full practice authority mean an NP can hire physicians?
Not necessarily. Full practice authority covers what the NP may do clinically. Whether an NP-owned entity can employ physicians depends on the state's corporate practice of medicine rules and professional entity statutes.
How many states give nurse practitioners full practice authority?
Our compiled data based on AANP classifications currently shows 28 jurisdictions including the District of Columbia with full practice, 12 with reduced practice, and 11 with restricted practice. Check AANP's current map before relying on these counts, since states change their laws regularly.
Can an NP-led telehealth company serve patients in all 50 states?
Yes, but the NP must be licensed where each patient is located and must meet that state's collaboration or supervision rules. To include physician services in strong CPOM states, most NP-founded brands use a friendly PC-MSO structure with a physician-owned PC.
Sources
- American Association of Nurse Practitioners: State Practice Environment
- Oregon Legislature: SB 951 (2025) measure overview
- California Legislative Information: SB 351 bill text
- Texas Medical Association: The Corporate Practice of Medicine white paper
Add the physician side when you need it
MyOrbitHealth offers physician PC owner services, including collaborating physician support, and PC-MSO formation for NP- and PA-founded brands that need a physician-owned practice entity. You can also launch on MyOrbitHealth's existing MSO / friendly-PC structure, with 2,400+ board-certified providers in all 50 states and licensed providers making every clinical decision. Book a call to map your states.
