Full practice authority
Full practice authority is a state licensure model that lets nurse practitioners evaluate, diagnose, order tests, and prescribe — including controlled substances in most such states — under the nursing board’s authority alone, without a physician collaboration or supervision agreement.
- Nursing-board authority; no physician agreement
- About half of states plus DC
- Applies by patient location
- Changes each legislative session
The three tiers
States sort into full practice (no physician agreement required, sometimes after a supervised transition period), reduced practice (a collaborative agreement required for some elements, usually prescribing), and restricted practice (physician supervision or delegation for all or most elements). Roughly half of states plus DC are full practice; the rest are split between the other two tiers, and lists change with each legislative session.
Why it matters for telehealth
The tier that applies is the one in the state where the patient is located during the visit, regardless of where the NP sits. A national program staffed by NPs therefore needs physician collaboration in reduced and restricted states even if every NP lives in a full-practice state. This is the operational reason most multi-state programs run through a physician-owned medical group that already holds the collaboration layer.
- Determined by the patient’s state, not the clinician’s
- Transition-to-practice periods apply in several full-practice states
- Controlled-substance authority can still carry extra conditions
- PAs follow a separate, mostly collaboration-based model
Compliance handled, so you can build
Lithos runs the clinicians, pharmacies, and 50-state rules behind your care program — one API.
Frequently asked questions
Which states give nurse practitioners full practice authority?
Roughly half of states and DC, concentrated in the West, Northwest, and Northeast, several with a supervised transition period first. Verify against the state board rather than relying on a list; the map changes yearly.
Can an NP in a full-practice state treat patients in a restricted state via telehealth?
Only by meeting the restricted state’s rules — typically a license there plus a collaboration or supervision agreement with a physician licensed in that state.
Do physician assistants have full practice authority?
PA rules are structured differently; most states require collaboration or supervision, with a growing number moving to practice-level rather than one-to-one arrangements.