Nurse Practitioner (NP)

Key facts

Education

Graduate nursing degree (MSN or DNP) in an NP program

Certification

National exams from bodies such as AANPCB and ANCC

Licensing

State boards of nursing; scope of practice varies by state

Medicare billing

Direct Part B payment at 85% of the physician fee schedule amount

Taxonomy code

363L00000X (Nurse Practitioner)

What is a nurse practitioner?

NPs are one of four advanced practice registered nurse (APRN) roles, alongside clinical nurse specialists, certified registered nurse anesthetists and certified nurse-midwives. Each NP trains and certifies in a population focus, such as family, adult-gerontology, pediatrics, women's health or psychiatric-mental health.

NPs work in primary care, specialty clinics, hospitals, urgent care, retail clinics and telehealth. Many practice in rural and underserved areas where physicians are scarce.

How NP scope of practice works

There is no single national rule. Each state decides, through statute and board regulation, whether NPs need a formal relationship with a physician to practice or prescribe. States are commonly sorted into three bands:

Details vary further within each band, including transition-to-practice periods for new NPs, limits on prescribing controlled substances and differences by care setting. To prescribe controlled substances, NPs also need a DEA registration. States keep changing these rules, so any state-by-state list needs a date.

• Full practice: NPs evaluate, diagnose, treat and prescribe under the state board of nursing without a required physician agreement.
• Reduced practice: state law requires a collaborative agreement with a physician for at least one element of practice, often prescribing.
• Restricted practice: state law requires physician supervision, delegation or team management.

Why NP data matters

NPs are a fast-growing part of the clinician workforce and write a meaningful share of prescriptions in many therapeutic areas, so commercial teams that target only physicians miss real prescribing volume. Workforce and access analyses that ignore NPs also understate primary care capacity.

NPs hold their own Type 1 NPIs and appear in NPPES, Medicare Part D prescriber data and, starting with 2021 data, Open Payments. In Medicare, services billed incident to a physician are reported under the physician's NPI, which can hide NP activity in claims data.