50-State Physician Guide

Licensure, practice ownership, and APC supervision rules — state by state. Click any state for the full breakdown.

States

AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

District of Columbia

DC

Territories

GU MP PR VI

Comparison Table

State IMLC FCVS NP Independent PA Independent Supervising MD In-State (APC) Physician PC Max NP:MD Max PA:MD License Renewal Cycle Annual Cost
Alabama Yes N/A No No Strict: Must be resident & practicing in AL. — Combined cap of 9 Full-Time Equivalents (FTE). Yes 9 9 $375 $300 Annual $300
Alaska Yes Accepted Yes Yes (authorizes physician assistants to work without operating under a specific collaborative agreement, but does not allow for independent licensure) None (Telehealth-friendly). — Decisions made at practice level. No No Limit No Limit $750 $350 Biennial $175
Arizona Yes N/A Yes Yes (those certified by the Arizona Regulatory Board of Physician Assistants to practice independently (no supervision agreement required) but in collaboration with a physician, and those who must practice according to a supervision agreement) None (Telehealth-friendly). No No Limit 4 $550 $500 Biennial $250
Arkansas Yes N/A Yes (6,240h) No Ready availability; no strict residency. — Board policy generally restricts to 3. No No Limit 3 $220 $300 Biennial $150
California No Accepted Yes (3 yrs) No Ready availability; physical presence not required. Yes (51%) 4 8 $805 $1,206 Biennial $603
Colorado Yes Accepted Yes Yes Telecommunication availability only. No No Limit No Limit $450 $327 Biennial $164
Connecticut Yes Accepted Yes (3 yrs) Yes (3 yrs) Resident/Practicing MD (For first 3 years/2,000 hours of NP practice) Yes No Limit No Limit $570 $565 Annual $565
Delaware Yes Accepted Yes Yes MD must be licensed/available. No No Limit 4 $440 $344 Biennial $172
District of Columbia Yes Accepted Yes No Must be licensed in DC. No No Limit No Limit $414 $714 Annual $714
Florida Yes Accepted Yes (engage in autonomous practice only in primary care practice, including family medicine, general pediatrics, and general internal medicine) No MD must be licensed in FL; residency not required. No No Limit 4 $355 $705 Biennial $353
Georgia Yes Accepted No No Strict: MD must be in-state or within 50 miles. Principle place in practice. GA narrowing in on telehealth. No 8 4 $500 $230 Biennial $115
Guam Yes Required No No Must be licensed in Guam. Yes No Limit No Limit $300 $300 Biennial $150
Hawaii Yes Accepted Yes No None (MD license only). No No Limit No Limit $500 $360 Biennial $180
Idaho Yes Accepted Yes Yes None. No No Limit No Limit $160 $160 Biennial $80
Illinois Yes Accepted Yes (an advanced practice registered nurse certified as a nurse midwife, clinical nurse specialist, or nurse practitioner who files ... an attestation of completion of at least 250 hours of continuing education) No MD must be "readily available." Yes No Limit 7 $500 $450 Triennial $150
Indiana Yes Accepted Yes (An advanced practice nurse shall operate in collaboration with a licensed practitioner as evidenced by a practice agreement) No MD must be licensed in IN. No No Limit 4 $250 $200 Biennial $100
Iowa Yes Accepted Yes Yes (requiring a licensed physician assistant to be supervised by a physician during the first two years of independent practice if the physician assistant has not previously practiced) None. No No Limit 5 $450 $450 Biennial $225
Kansas Yes Accepted Yes No MD must be licensed in KS. — Determined by practice agreement. Yes No Limit No Limit $300 $330 Annual $330
Kentucky Yes Required Yes No MD must be licensed/practicing in KY. No No Limit 4 $300 $150 Annual $150
Louisiana Yes Required No No MD must be "comparable specialty" in-state. No No Limit 8 $382 $350 Annual $350
Maine Yes Required Yes (When an NP completes 24 months of physician or nurse practitioner supervision he/she must ensure) Yes (Please note that as of 4/3/26 Practice Agreements are no longer required for Physician Associates with more than 4,000 verified clinical hours. Requirements for Physician Associates with less than 4,000 clinical hours remain the same.) None. No No Limit No Limit $700 $500 Biennial $250
Maryland Yes Required Yes No MD must be licensed in MD. No No Limit No Limit $310 $486 Biennial $243
Massachusetts No Required Yes (2 yrs) No MD must be licensed/practicing in MA. Redily Available during the 18-month "mentorship" period. Yes No Limit 4 $600 $600 Biennial $300
Michigan Yes Accepted No Yes MD must be licensed in MI. — Determined at the practice level. Yes No Limit No Limit $375 $314 Triennial $105
Minnesota Yes Accepted Yes Yes (A physician assistant who qualifies for licensure must practice for at least 2,080 hours, within the context of a collaborative agreement, within a hospital or integrated clinical setting where physician assistants and physicians work together to provide patient care.) None. No No Limit No Limit $425 $384 Annual $384
Mississippi Yes Accepted No No Strict: MD must be within 75 miles of site. 80 hours a month and 20 hours a week in state in person. Never approve excemptions purely telehealth based. No 4 4 $550 $300 Annual $300
Missouri Yes Accepted No No Strict: MD must be within 75 miles of site. (CHANGED THEIR LAW ON THIS - telehealth) — Combined max of 6 (FTE). No 6 6 $102 $147 Annual $147
Montana Yes Accepted Yes Yes (A physician assistant with fewer than 8,000 hours of postgraduate clinical experience shall practice medicine with a collaborative agreement) None. No No Limit No Limit $375 $500 Biennial $250
Nebraska Yes Accepted Yes No MD must be licensed in NE. No No Limit No Limit $300 $200 Biennial $100
Nevada Yes Accepted Yes Yes MD must be licensed in NV. Yes No Limit No Limit $600 $800 Biennial $400
New Hampshire Yes Required Yes Yes None. No No Limit No Limit $600 $300 Biennial $150
New Jersey Yes Accepted No No MD must be licensed in NJ. — Determined by the Board of Medical Examiners. Yes No Limit No Limit $328 $620 Biennial $310
New Mexico No Accepted Yes Yes (3 yrs) None. No No Limit No Limit $700 $400 Triennial $133
New York No Required Yes (does not require an NP to practice under physician supervision) No MD must be licensed/practicing in NY. — Hospitals may have separate bylaws. Yes No Limit 4 $735 $600 Biennial $300
North Carolina Yes Required No Yes (4,000h) MD must be "readily available". Physician must be reachable at all times during patient care. Yes No Limit 4 $440 $250 Annual $250
North Dakota Yes Accepted Yes Yes None. No No Limit No Limit $200 $405 Biennial $203
Northern Mariana Islands No Accepted No No Must be licensed in CNMI. Yes No Limit No Limit $500 $400 Biennial $200
Ohio Yes Required No No MD must be practicing in similar field in-state. Yes No Limit 5 $305 $305 Biennial $153
Oklahoma Yes Accepted No Yes (6,240h — Most restrictive PA ratio in the US.) MD must visit monthly (DO) or be available (MD). No No Limit 2 $500 $300 Annual $300
Oregon No Accepted Yes Yes None. No No Limit No Limit $575 $756 Biennial $378
Pennsylvania Yes Accepted No No MD must be licensed in PA. MD must be available on a "regularly scheduled basis" — Recently increased from 4 to 6. No No Limit 6 $35 $360 Biennial $180
Puerto Rico No Accepted No No Must be licensed in PR. Yes No Limit No Limit $500 $400 Triennial $133
Rhode Island No Required Yes Yes MD must be licensed in RI. Yes No Limit No Limit $1,090 $1,090 Biennial $545
South Carolina No Required No No Strict: MD must reside/practice in SC. No 6 6 $580 $155 Biennial $78
South Dakota Yes Accepted Yes No None. No No Limit No Limit $400 $200 Annual $200
Tennessee Yes Accepted No No MD must be within "reasonable" distance. Once annual site (11 virtual, 1 in-person). Board advisory ruling, can take place for telehealth. Location for telehealth for site visit, can be a site mutually agreed upon. NP doesn't have to b present. No No Limit 4 $510 $400 Biennial $200
Texas Yes Accepted No No MD must be licensed in TX; monthly meetings. — Combined max of 7. Yes 7 7 $817 $500 Biennial $250
U.S. Virgin Islands No Required No No Must be licensed in USVI. Yes No Limit No Limit $350 $350 Biennial $175
Utah Yes Required Yes Yes None. No No Limit No Limit $200 $183 Biennial $92
Vermont Yes Accepted Yes No None. No No Limit No Limit $650 $525 Biennial $263
Virginia No Accepted Yes (A nurse practitioner who has completed the equivalent of at least three years of full-time clinical experience may practice without a written or electronic practice agreement upon receipt of an attestation) No MD must be "regularly practicing" in VA. Yes 6 6 $302 $337 Biennial $169
Washington Yes Accepted Yes Yes (A physician assistant who has completed fewer than 4,000 hours of postgraduate clinical practice must work under the supervision of a participating physician, as described in the collaboration agreement) None. No No Limit No Limit $511 $996 Biennial $498
West Virginia Yes Accepted Yes (the board shall, upon application, authorize an advanced practice registered nurse to prescribe prescription drugs...without the further requirement of a collaborative agreement if the applicant has satisfied the following prerequisites: (1) Has practiced at least three years in a duly-documented collaborative relationship with granted prescriptive authority) No MD must be licensed in WV. No No Limit 5 $400 $400 Biennial $200
Wisconsin Yes Accepted Yes (an APRN who has completed all of the following may engage in independent practice: 3,840 hours of professional nursing in a clinical setting, during which at least 24 months have elapsed since the APRN first began the required hours.) No MD must be licensed in WI. — Determined at the practice level. No No Limit No Limit $75 $412 Biennial $206
Wyoming Yes Required Yes Yes None. No No Limit No Limit $400 $300 Annual $300

Data compiled from state medical board websites, FSMB, and regulatory filings. Per-section verification dates: data freshness. Report corrections.