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Nurse Practitioner Practice Authority by State

Where you can practice independently depends entirely on the state. This guide defines an NP's scope of practice, explains the three levels of practice author…

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Key Takeaways

  • States grant NP practice authority at three levels, full, reduced, or restricted, which set how far an NP can diagnose, prescribe, and run an independent practice.
  • 27 states, Washington D.C., and two US territories grant full practice authority. 15 jurisdictions allow reduced authority, and 11 require physician supervision.
  • The trend runs toward expanding full practice authority, which widens patient access to providers who can diagnose and treat.

Where you can practice independently depends entirely on the state. This guide defines an NP's scope of practice, explains the three levels of practice authority, and lists states by authority level so you know what you can do before you sign a contract.

What Scope of Practice Means

Scope of practice is the set of clinical activities a state authorizes you to perform. For an NP that can include assessing a patient, ordering and interpreting tests, making diagnoses, prescribing medication, and ordering treatments.

Scope varies by state. Some states require you to work under or in collaboration with a physician. Others let you practice independently.

The Three Levels of Practice Authority

Scope of practice falls into three levels: full, reduced, or restricted.

Full Practice

You perform your full scope of practice with no supervising or collaborating physician. You can diagnose, order tests, prescribe, and run your own practice. Some full practice states require a set period of supervised experience or extra training before granting independence. Because those requirements are temporary, the state still counts as full practice.

Reduced Practice

You perform part of your scope without physician oversight. The limits usually apply to running your own practice or prescribing certain medications, not to ordering tests or diagnosing. A common setup: you join a physician-supervised practice but operate with broad autonomy inside it.

Restricted Practice

You work under physician supervision for your entire scope of practice. You may still have wide autonomy in specific functions, but you are not an independent practitioner. Some states loosen restrictions as you gain experience.

States by Nurse Practitioner Practice Authority

Each state sets its own rules. Use the official board and statute links below to confirm current requirements before you make a decision.

Full Practice Authority States and Territories

Alaska

Arizona

Colorado

Connecticut

Delaware

Guam

Hawaii

Idaho

Iowa

Kansas

Maine

Maryland

Massachusetts

Minnesota

Montana

Nebraska

Nevada

  • Board of Nursing
  • Nursing Statutes and Regulations

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 Authority States

Alabama

American Samoa

Arkansas

  • Board of Nursing
  • Nursing Statutes and Regulations

Illinois

Indiana

Kentucky

Louisiana

Mississippi

New Jersey

Ohio

  • Board of Nursing
  • Nursing Statutes and Regulations

Pennsylvania

Puerto Rico

U.S. Virgin Islands

West Virginia

Wisconsin

Restricted Practice Authority States

California

  • Nursing Statutes and Regulations

Florida

Georgia

Michigan

Missouri

North Carolina

Oklahoma

South Carolina

Tennessee

Texas

Virginia

The Push for Full Practice Authority

Expanding NP authority has clear upsides for patients. It adds providers who can diagnose and treat, it eases primary care shortages, and because NP salaries run below physician salaries, it lowers the cost of care.

The pushback comes mostly from physician organizations. They argue that complex conditions belong with physicians, and that insurers may steer patients toward NPs to cut costs, which they say risks lower quality care for serious cases. Physicians also earn revenue from supervising NPs and lose that income when NPs practice independently. Given how fast the number of full practice states has grown, most state legislatures have sided with expanded authority.

Frequently Asked Questions About Nurse Practitioner Practice Authority

Where can NPs practice independently? In full practice authority states, NPs can run independent practices. As of 2025, that covers 27 states, Washington D.C., and two US territories. In reduced or restricted states, NPs work in collaboration with or under the supervision of a physician, though many still diagnose and treat with a high degree of independence. This list keeps growing as more states pass expansion legislation.

Who licenses NPs? The state where you practice, or a multistate license. State boards of nursing set the criteria: graduate from an accredited program, pass a certification exam, and maintain licensure through continuing education.

Does full practice authority mean no oversight at all? Yes for clinical scope. Some full practice states still require a period of supervised experience or extra training before granting independence, but those conditions are temporary.

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