# Nurse practitioner full practice authority states in 2026 Source: https://myorbithealth.com/compliance/nurse-practitioner-full-practice-authority-states As of October 2026, 28 jurisdictions (27 states plus the District of Columbia) give nurse practitioners full practice authority, 12 states classify NP practice as reduced, and 11 classify it as restricted. The classifications follow the American Association of Nurse Practitioners (AANP) state practice environment map, with data dated May 2026, and the lists below are computed from the 51-row dataset behind our state compliance report. The split matters for a telehealth brand because it decides whether an NP can see patients under the nursing board alone or needs a career-long collaborative or supervisory agreement with a physician in that state. Restricted states include California, Florida and Texas, which are also three of the largest telehealth markets. The APRN Compact would not change any of this: it is not active and needs seven enacting states. This is general information, not legal advice. ## What full, reduced and restricted practice mean AANP publishes the definitions most operators and most state pages use. The three categories describe what state law lets an NP do under the nursing board's authority alone, not how good any individual NP is. - **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. ## The 28 full practice jurisdictions (27 states plus DC) Alphabetical. Each row cross-references the same state's compact and corporate practice status from our dataset, because an NP-led program in a full-practice state can still be blocked by a strong corporate practice rule or by a physician licensing gap. - **Alaska:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: None. - **Arizona:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **Colorado:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Strong. - **Connecticut:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **Delaware:** IMLC member; PA Compact enacted; APRN Compact enacted; CPOM: None. - **District of Columbia:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Limited or unsettled. - **Hawaii:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Limited or unsettled. - **Idaho:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Limited or unsettled. - **Iowa:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **Kansas:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **Maine:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: None. - **Maryland:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Moderate. - **Massachusetts:** Not an IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Strong. - **Minnesota:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **Montana:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Limited or unsettled. - **Nebraska:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: None. - **Nevada:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Strong. - **New Hampshire:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: None. - **New Mexico:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: None. - **New York:** Not an IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Strong. - **North Dakota:** IMLC member; PA Compact enacted; APRN Compact enacted; CPOM: Strong. - **Oregon:** Not an IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Strong. - **Rhode Island:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **South Dakota:** IMLC member; PA Compact enacted; APRN Compact enacted; CPOM: Moderate. - **Utah:** IMLC member; PA Compact enacted; APRN Compact enacted; CPOM: None. - **Vermont:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: None. - **Washington:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **Wyoming:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: None. ## The 12 reduced practice states Alphabetical. In each of these a career-long collaborative agreement, or a setting limitation, applies. For a telehealth brand the operational question is who holds the collaborating physician relationship and whether it is written for that state's rules. - **Alabama:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: None. - **Arkansas:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **Illinois:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Strong. - **Indiana:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Moderate. - **Kentucky:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Limited or unsettled. - **Louisiana:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Limited or unsettled. - **Mississippi:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Limited or unsettled. - **New Jersey:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Strong. - **Ohio:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Limited or unsettled. - **Pennsylvania:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Moderate. - **West Virginia:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **Wisconsin:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. ## The 11 restricted practice states Alphabetical. Career-long supervision, delegation or team management is required. These 11 states, California, Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia, include several of the largest telehealth markets, so a national program cannot be NP-only. - **California:** Not an IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Strong. - **Florida:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: None. - **Georgia:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Limited or unsettled. - **Michigan:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Strong. - **Missouri:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: None. - **North Carolina:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Strong. - **Oklahoma:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: None. - **South Carolina:** Not an IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Moderate. - **Tennessee:** IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: Moderate. - **Texas:** IMLC member; PA Compact not enacted; APRN Compact not enacted; CPOM: Strong. - **Virginia:** Not an IMLC member; PA Compact enacted; APRN Compact not enacted; CPOM: None. ## Why it matters for telehealth staffing Most direct-to-consumer telehealth is NP-heavy for a simple reason: NPs are more available and cost less per visit than physicians. The practice-environment map is what turns that staffing preference into a legal structure. - **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. ## APRN Compact status: not active in 2026 The APRN Compact is the nursing analogue to the physicians' IMLC, but it is not in force. Per NCSBN news releases, 4 states have enacted it: Delaware, North Dakota, South Dakota and Utah. The compact needs seven to activate. NCSBN's 2026 APRN Roundtable transcript says the NCSBN Board has charged staff to redesign the compact, which suggests the current text is unlikely to reach the threshold in its present form. The compact's own site, aprncompact.com, publishes no member list, and we do not count secondary-source claims of a fifth state. Bottom line for staffing: assume an NP needs a separate license, and where applicable a separate collaborative or supervisory agreement, in every state served. Note also that the APRN Compact, if it ever activates, would address licensure only; it does not override a state's practice authority rules, so a restricted state stays restricted. ## How MyOrbitHealth staffs across all three categories MyOrbitHealth is a technology company and does not practice medicine. Care is delivered by licensed providers under an MSO and friendly-PC structure. The staffing design below is what lets one program run across full, reduced and restricted states without the brand managing agreements. - **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. ## FAQ ### How many states have full practice authority for nurse practitioners in 2026? 27 states plus the District of Columbia, 28 jurisdictions in all, per the AANP practice environment data dated May 2026 as captured in our October 2026 dataset. 12 states are reduced and 11 are restricted. ### Is Texas a full practice authority state? No. Texas is restricted. NPs practice under a physician's delegation with prescriptive authority agreements, so Texas telehealth staffing needs physicians who hold Texas licenses. The same is true in California and Florida. ### What is the difference between reduced and restricted practice? Reduced requires a career-long collaborative agreement, or limits the setting of some element of practice. Restricted requires career-long supervision, delegation or team management by another provider. Restricted is the heavier obligation, with ratios and review requirements that make NP-only staffing unworkable. ### Which states have enacted the APRN Compact? Delaware, North Dakota, South Dakota and Utah, per NCSBN news releases. That is 4 of the seven needed. The compact is not active, and NCSBN said in 2026 that it is redesigning it. ### Does full practice authority let an NP own the telehealth clinic? Not necessarily. Practice authority is about scope. Who may own a professional entity is a corporate practice question, and the 6 full-practice jurisdictions in our dataset with strong corporate practice rules still constrain ownership. See the corporate practice of medicine hub. ### Do I need a collaborating physician in every state? In the 23 reduced and restricted states, yes, in a form that satisfies that state's statute and with a physician licensed there. In the 28 full-practice jurisdictions, no, although some require a transition-to-practice period for new NPs. ### How does MyOrbitHealth handle NP staffing in restricted states? The network includes MD, DO, NP and PA providers in all 50 states, and routing matches each visit to a provider whose license and practice authority fit the patient's state. Where a collaborative or supervisory relationship is required, it is maintained inside the network's professional entities rather than by the brand. ## Staff all 50 states without a 50-state collaboration spreadsheet MyOrbitHealth's 2,400+ provider network covers MD, DO, NP and PA across every practice-environment category, with collaborating-physician rules handled inside the network. Book a call at https://myorbithealth.com/book or see /provider-network. Book a call: https://myorbithealth.com/book Go deeper: [Collaborating physician agreements explained](https://myorbithealth.com/blog/collaborating-physician), [Telehealth staffing: provider network vs hiring your own](https://myorbithealth.com/blog/telehealth-staffing-provider-network-vs-hiring), [How to find a 50-state physician network](https://myorbithealth.com/blog/find-50-state-physician-network), [Best telehealth provider networks compared](https://myorbithealth.com/blog/best-telehealth-provider-networks) _General information, not legal or medical advice._ _Source: https://myorbithealth.com/compliance/nurse-practitioner-full-practice-authority-states_