How to Start an NP Practice in North Carolina: Dual-Board Oversight and the CPA Requirement
By Jody Mitchell, MD | July 1, 2025
A colleague who had been practicing as an NP in Arizona for seven years moved to North Carolina and assumed the process would be similar. She was stunned to learn that North Carolina has dual-board oversight -- the Board of Nursing AND the Medical Board both regulate NP practice -- and that she would need a Collaborative Practice Agreement with a physician before she could see a single patient. The regulatory structure in North Carolina is unlike anything she had encountered, and it took her four months longer to open than she had planned.
A colleague who had been practicing as an NP in Arizona for seven years moved to North Carolina and assumed the process would be similar. Arizona is a full practice authority state. NPs there can practice independently from day one. She had built a successful primary care practice in Scottsdale, sold it, and relocated to Raleigh to be closer to family.
She was stunned to learn that North Carolina has dual-board oversight -- the Board of Nursing AND the Medical Board both regulate NP practice -- and that she would need a Collaborative Practice Agreement with a physician before she could see a single patient. Seven years of independent practice experience counted for nothing under North Carolina law.
The regulatory structure in North Carolina is unlike anything she had encountered, and it took her four months longer to open than she had planned. But once she understood the framework and worked through each requirement systematically, she built a thriving family practice in a Raleigh suburb that serves over 800 patients.
North Carolina is a restricted practice state -- the most restrictive category in the AANP's classification system. But "restricted" does not mean "impossible." It means the rules are specific, the oversight is layered, and the preparation needs to be thorough. This guide walks through every step.
Dual-Board Oversight: The North Carolina Difference
This is the single most important structural fact about NP practice in North Carolina, and it catches nearly every out-of-state NP off guard.
In most states, NPs are regulated by the Board of Nursing. In North Carolina, NPs are regulated by both the North Carolina Board of Nursing (NCBON) and the North Carolina Medical Board (NCMB). These two boards jointly oversee NP practice through the Joint Subcommittee on Nurse Practitioners, which was created by the legislature to coordinate regulatory oversight.
What this means practically: