Nurse practitioner full practice authority states in 2026

Full practice

Per AANP, state practice and licensure laws permit all NPs to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.

Some full-practice states still require a transition-to-practice period of supervised hours for new NPs before independence attaches, so check the fine print when a newly licensed NP is on the roster.

Reduced practice

AANP's definition: state law reduces the ability of NPs to engage in at least one element of NP practice, and requires a career-long regulated collaborative agreement with another health provider for the NP to provide patient care, or limits the setting of one or more elements of NP practice.

In telehealth terms, a reduced state means a collaborating physician agreement must exist in that state before the NP's first visit there, and it must stay current.

Restricted practice

AANP's definition: state law restricts the ability of NPs to engage in at least one element of NP practice and requires career-long supervision, delegation or team management by another health provider.

Restricted states typically cap how many NPs a physician may supervise, set chart review and meeting requirements, and tie prescriptive authority to the supervising physician's delegation. These are the states where NP-only staffing fails.

Why the label is not the whole story

Two full-practice states can differ on controlled substance prescribing by telehealth, on whether an NP can own the professional entity, and on corporate practice rules that apply to the whole clinic.

Read this page with the CPOM hub and the IMLC hub; the row notes here cross-reference both.

Collaborating physician agreements are per state, not per NP

In the 23 reduced and restricted states an NP needs a physician relationship that satisfies that state's statute: the right form, the right ratio, the right chart-review cadence, and a physician who is licensed in that state.

A brand that signs one national 'collaboration' contract and assumes it covers 50 states has, in practice, covered the 28 full-practice jurisdictions and nothing else. The mechanics are covered in our collaborating physician guide at /blog/collaborating-physician.

Async intake changes who sees the patient

If your model uses asynchronous intake with a provider review rather than a live video visit, the state's rules on asynchronous care and on NP prescribing both apply.

In a restricted state the supervising physician's delegation must cover the asynchronous protocol as well. Orbit Intake collects the history and flags red lines; the routing layer still has to pick a provider whose license and practice authority match the patient's state.

Cost follows the map

Physician time is the expensive input.

• In restricted states some of it is unavoidable: supervision hours, chart reviews, and in some states the physician must be the prescriber of record for certain drugs.
• Budget physician coverage by state mix, not by national average.
• A brand that sells mostly in Texas, Florida and California should expect a higher physician share than one concentrated in the Mountain West.

Controlled substances add a second layer

Practice authority is about the nursing board.

• DEA registration, EPCS, and state controlled-substance rules sit on top of it.
• An NP with full practice authority in Washington still needs the right DEA registration and, for telehealth prescribing of controlled substances, must follow the federal telemedicine rules in force at the time.
• The platform's EPCS and identity-proofing layer handles the technical side; the legal side is still per state.

Mixed MD, DO, NP and PA network

The Provider Network has 2,400+ board-certified providers across MD, DO, NP and PA license types, 38+ specialties and all 50 states.

Routing uses live availability and load balancing, so a patient in a restricted state is matched to a provider whose license and practice authority fit that state, and a patient in a full-practice state can be matched to an NP where that is appropriate. Average response is under six minutes during business hours, with 24-hour visit availability.

Collaborating-physician rules handled in the network

Where a state requires a collaborative or supervisory physician relationship for an NP, that relationship is established and maintained inside the network's professional entities, not by your brand.

You do not recruit a collaborating physician per state or track ratios and chart-review cadences. For the detail on how those agreements work, read /blog/collaborating-physician.

Credentialing and coverage

Every provider goes through NCQA-standard primary-source credentialing with monthly OIG and SAM exclusion screening.

• Malpractice is occurrence-based with $1 million per occurrence and $6 million aggregate limits.
• Bring-your-own-providers is supported; they are credentialed to the same standard.
• 50+ digital clinics run on the platform, which is HIPAA compliant with a BAA in every contract and SOC 2 Type II.