Nurse practitioners and APRNs
Your nurse practitioners cost three times what your physicians do.
This is the reason the company is not called MultiStateMD.
$259
A physician's second through Nth state at the market leader, because the compact does the work.
$759
An APRN's second state, because nothing does the work.
461,000
Licensed nurse practitioners in the United States.
41% vs 4%
Nurse practitioner growth against physician growth.
The compact will not rescue this
The APRN Compact holds five of the seven states it needs to activate. It is not issuing licenses and will not before 2028. Even at activation, each state keeps control of prescriptive authority, which is the part that determines whether the clinician can actually work.
Compact status verified 14 September 2026.
Four to seven filings against a physician's one
Per APRN, per state, the group is carrying:
- An RN license, where the Nurse Licensure Compact does not reach
- An APRN license
- Prescriptive authority, granted separately from the license
- A collaborative practice agreement, in roughly 25 states
- A state controlled substance registration
- A state-specific DEA registration
- Individual payer enrollment with Medicare and every commercial plan
Incident-to billing does not apply to telehealth
A virtual-first group cannot shelter mid-level clinicians under a supervising physician's NPI. Every nurse practitioner and physician assistant needs individual enrollment with Medicare and with every commercial payer, in every state where they see patients. Groups that assumed otherwise discover it during a payer audit, retrospectively.
The clock count
A six-state APRN with prescriptive authority carries roughly 10 to 14 distinct requirement sets running on 7 to 9 separate clocks. No two of those clocks renew on the same cycle.
States treat national certification three different ways
| Treatment | States |
|---|---|
| Fully satisfies state CE | Iowa, Missouri, Oklahoma, Tennessee |
| Partially satisfies state CE | Oregon, New Mexico |
| Does not satisfy state CE | California, Illinois, New York, New Jersey, Minnesota, Delaware, Washington, District of Columbia |
A group tracking one certification date per clinician and assuming it covers the states is wrong in the majority of its footprint.
Map your APRN requirements
Free, two business days. We return every requirement set, every clock and every gap for the nurse practitioners and physician assistants on your roster.