Nurse practitioners can open their own independent practice in more than half of U.S. states, plus the District of Columbia and several territories. These are states with what’s known as “full practice authority,” where NPs can evaluate patients, diagnose conditions, prescribe medications (including controlled substances), and manage treatment without a physician’s oversight or collaborative agreement. In the remaining states, opening a practice is still possible but comes with legal strings attached.
States With Full Practice Authority
Full practice authority (FPA) means state law allows NPs to do everything within their scope of training without a physician relationship written into law. The following states and territories currently grant FPA: Alaska, Arizona, Colorado, Connecticut, Delaware, the District of Columbia, Guam, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Northern Mariana Islands, Oregon, Rhode Island, South Dakota, U.S. Virgin Islands, Vermont, Washington, and Wyoming.
In these locations, you can open a clinic, see patients, and prescribe Schedule II through V controlled substances under your own license. There’s no requirement for a collaborating physician, no written supervision agreement, and no physician co-signature on prescriptions. You function as a fully independent provider from a legal standpoint.
Some FPA states still require a transition period before you can practice completely independently. Several states mandate supervised practice hours, ranging from about 1,040 to 4,000 hours, before you’re exempt from collaborative requirements. Oklahoma, which overturned a governor’s veto in 2025 to expand NP prescribing rights, requires 6,240 hours of physician supervision in the same specialty before granting independent prescriptive authority. Wisconsin is moving toward a similar model requiring 3,840 clinical hours as an NP over 24 months with a physician or dentist, plus an additional 3,840 hours of professional nursing in a clinical setting.
States With Reduced Practice
Reduced practice states require NPs to maintain a career-long collaborative agreement with a physician or other health provider. This doesn’t necessarily prevent you from owning a practice, but it means you must have a formal, written agreement that spells out your scope of practice, consultation and referral processes, and emergency protocols. You can’t simply hang a shingle and operate on your own authority.
The practical requirements of these agreements vary. Some states require the collaborating physician to be available by phone or telecom. Others mandate periodic chart reviews, often covering about 10% of patient records. Some impose geographic proximity restrictions, requiring the physician to be within 30 to 75 miles of your practice site, or to visit the practice quarterly. These relationships typically involve paying the collaborating physician a fee, which adds to your overhead.
You can still own the business entity in most reduced practice states. The collaborative agreement is a clinical oversight requirement, not a business ownership restriction. But finding and retaining a collaborating physician can be a real barrier, especially in rural areas where physicians are scarce.
States With Restricted Practice
Restricted practice states impose the tightest limits. State law requires career-long supervision, delegation, or team management by a physician. This goes beyond collaboration into active oversight of your clinical work. In these states, opening an independent practice is the most difficult because the physician relationship is more hands-on and more legally embedded in how you deliver care.
Again, business ownership may still be legally separate from clinical practice authority. Some NPs in restricted states own practices by hiring a medical director or maintaining a supervision arrangement. But the cost, complexity, and dependence on another provider make this a heavier lift than in FPA or reduced practice states.
States With Active Legislation
The trend has moved steadily toward granting NPs more independence. As of late 2025, at least a dozen scope-of-practice bills are active in Michigan, New Jersey, Ohio, and Pennsylvania. If you’re in one of these states, the rules could shift in the near future. Checking with your state board of nursing or the American Association of Nurse Practitioners for the latest status is worth doing before you commit to a business plan built around current restrictions.
Prescribing Authority Varies Even in FPA States
Independent practice authority and prescribing authority don’t always line up perfectly. Most FPA states allow NPs to prescribe Schedule II through V controlled substances without a physician co-signature. Alaska, Arizona, Delaware, Hawaii, Idaho, Iowa, Kansas, New Hampshire, North Dakota, Oregon, Rhode Island, Washington, and Wyoming all grant this. Montana is an exception: NPs there can independently prescribe Schedule III through V substances, but Schedule II prescribing is limited to emergencies.
If your practice involves pain management, psychiatric medications, or other controlled substances, verify the specific prescribing rules in your state. Having full practice authority for patient care doesn’t automatically mean unrestricted prescribing in every category.
Medicare Reimbursement for Independent NPs
One financial reality that affects every NP-owned practice: Medicare pays NPs at 85% of the physician fee schedule when you bill independently. After the standard 20% patient copay, Medicare covers 80% of that 85% rate. This 15% reduction compared to physician billing applies regardless of what state you’re in. If your NP services are billed as “incident to” a physician’s services (meaning a physician initiated the treatment plan and is on-site), reimbursement jumps to 100% of the physician rate, but that model requires a physician presence and defeats the purpose of a fully independent practice.
Private insurer reimbursement rates vary widely by carrier and state. Some insurers credential and reimburse NPs at the same rate as physicians; others mirror Medicare’s discount. Building your financial projections around the 85% Medicare rate gives you a realistic baseline for revenue planning.
Practical Steps Before Opening
Even in full practice authority states, opening a practice involves more than clinical licensure. You’ll need to obtain a National Provider Identifier, get credentialed with insurance panels (which can take three to six months), secure a DEA registration for prescribing controlled substances, and meet your state’s business licensing requirements. Malpractice insurance is essential, and premiums for independent NPs are generally lower than for physicians but vary by specialty and state.
If you’re in a reduced or restricted state and plan to own a practice with a collaborative agreement, get that agreement in writing before you sign a lease or invest in buildout. Losing your collaborating physician after you’ve opened can force you to suspend patient care until you find a replacement, which is a financial and ethical risk worth planning around from day one.