North Carolina Requirements at a Glance
Practice Authority
North Carolina is a Restricted Practice state (per AANP classification). Before performing medical acts, an NP must have Board approval to practice and a Collaborative Practice Agreement (CPA) with a primary supervising physician. The CPA requirement continues for the NP’s entire career in North Carolina.
Path to Independence
No. North Carolina law requires NPs to practice under physician supervision. Full-practice-authority bills, most recently S537/H514, have been introduced in successive legislative sessions but have not been enacted.
Hours Required for Independence
N/A. No independence pathway currently exists in North Carolina.
Physician-to-APC Provider Ratio Cap
No fixed numeric cap. The North Carolina Medical Board considers the number of supervisees, among other factors, in judging whether a physician’s supervision is adequate.
Chart Review Requirements
No fixed percentage. The physician and NP must maintain an ongoing quality improvement process, including a written plan for evaluating care for one or more frequently encountered clinical problems. The plan describes the problem, evaluates current treatment, and, if needed, sets out a plan for improving outcomes within a defined time frame.
Meeting Requirements
Monthly for the first 6 months of a new CPA, then at least every 6 months. Meeting documentation must identify the clinical issues discussed and actions taken, be signed and dated by attendees, and be kept by both the NP and the primary supervising physician for 5 years. The CPA itself must be reviewed at least annually, acknowledged by a dated signature sheet signed by both parties.
Geographic Requirements
No mileage or proximity rule. The supervising physician(s) and NP must be continuously available to each other for consultation by direct communication or telecommunication. The Medical Board treats geographic distance as one factor in whether supervision is adequate.
Prescriptive/Delegation Authority Agreement
A CPA; no specific format is required. At a minimum, the CPA must list the drugs, devices, medical treatments, tests, and procedures the NP may prescribe, order, and perform, and include a pre-determined plan for emergency services. It must be signed and dated by the NP and the primary supervising physician and kept at each practice site. Any back-up supervising physician must also be a party to the CPA.
Schedule II Prescribing
Permitted under the CPA. Schedules II–V may be prescribed as established in the CPA, provided the NP has a DEA number entered on each controlled-substance prescription and the primary supervising physician holds the same or greater controlled-substance schedules.
Before prescribing a targeted controlled substance for more than 30 days to a patient of a facility that primarily treats pain with narcotic medications, the NP must personally consult the supervising physician, and then at least every 90 days while the prescription continues. Initial prescriptions of targeted controlled substances for acute pain are limited to a 5-day supply (7 days for post-operative pain).
Physician Collaboration Eligibility Requirements
A collaborating physician in North Carolina must:
- Hold an active, unencumbered North Carolina medical license
- Not be a physician in a graduate medical education program (whether fully licensed or holding only a resident’s training license)
- Hold controlled-substance schedules equal to or greater than the NP’s DEA registration
- Supervise only care for which they have appropriate education, training, experience, or certification
Back-up physician coverage is not universally required. If you have one, the back-up collaborating physician must be licensed in North Carolina and be a party to the CPA.
DEA Requirements / Application Process
The NP must have Board approval to practice and an individual DEA registration for North Carolina to prescribe any controlled substance. The NP’s DEA number must appear on each controlled-substance prescription.
Boards, Trade Associations & Authoritative Links
North Carolina Board of Nursing (NCBON) — Nurse Practitioner Practice
NCBON — Nurse Practitioner Collaborative Practice Guidelines
North Carolina Medical Board (NCMB)
NCMB Position Statement 9.1.1 — Physician Supervision of Other Licensed Health Care Professionals
N.C. Gen. Stat. § 90-18.2 (Limitations on Nurse Practitioners)
21 NCAC 36 .0810 (Quality Assurance Standards for a Collaborative Practice Agreement)
Disclaimer: This page for general informational purposes only and is not legal or medical advice. North Carolina requirements are set by state law and board rule and may change; consult your own counsel before relying on this information. CollabDocs facilitates physician-APC introductions and does not practice medicine or guarantee outcomes except as stated in a signed services agreement.
Reviewed by the CollabDocs Compliance Team | Last reviewed October 19, 2026
North Carolina Requirements at a Glance
Practice Authority
North Carolina is a Restricted Practice state (per AANP classification). Before performing medical acts, an NP must have Board approval to practice and a Collaborative Practice Agreement (CPA) with a primary supervising physician. The CPA requirement continues for the NP’s entire career in North Carolina.
Path to Independence
No. North Carolina law requires NPs to practice under physician supervision. Full-practice-authority bills, most recently S537/H514, have been introduced in successive legislative sessions but have not been enacted.
Hours Required for Independence
N/A. No independence pathway currently exists in North Carolina.
Physician-to-APC Provider Ratio Cap
No fixed numeric cap. The North Carolina Medical Board considers the number of supervisees, among other factors, in judging whether a physician’s supervision is adequate.
Chart Review Requirements
No fixed percentage. The physician and NP must maintain an ongoing quality improvement process, including a written plan for evaluating care for one or more frequently encountered clinical problems. The plan describes the problem, evaluates current treatment, and, if needed, sets out a plan for improving outcomes within a defined time frame.
Meeting Requirements
Monthly for the first 6 months of a new CPA, then at least every 6 months. Meeting documentation must identify the clinical issues discussed and actions taken, be signed and dated by attendees, and be kept by both the NP and the primary supervising physician for 5 years. The CPA itself must be reviewed at least annually, acknowledged by a dated signature sheet signed by both parties.
Geographic Requirements
No mileage or proximity rule. The supervising physician(s) and NP must be continuously available to each other for consultation by direct communication or telecommunication. The Medical Board treats geographic distance as one factor in whether supervision is adequate.
Prescriptive/Delegation Authority Agreement
A CPA; no specific format is required. At a minimum, the CPA must list the drugs, devices, medical treatments, tests, and procedures the NP may prescribe, order, and perform, and include a pre-determined plan for emergency services. It must be signed and dated by the NP and the primary supervising physician and kept at each practice site. Any back-up supervising physician must also be a party to the CPA.
Schedule II Prescribing
Permitted under the CPA. Schedules II–V may be prescribed as established in the CPA, provided the NP has a DEA number entered on each controlled-substance prescription and the primary supervising physician holds the same or greater controlled-substance schedules.
Before prescribing a targeted controlled substance for more than 30 days to a patient of a facility that primarily treats pain with narcotic medications, the NP must personally consult the supervising physician, and then at least every 90 days while the prescription continues. Initial prescriptions of targeted controlled substances for acute pain are limited to a 5-day supply (7 days for post-operative pain).
Physician Collaboration Eligibility Requirements
A collaborating physician in North Carolina must:
- Hold an active, unencumbered North Carolina medical license
- Not be a physician in a graduate medical education program (whether fully licensed or holding only a resident’s training license)
- Hold controlled-substance schedules equal to or greater than the NP’s DEA registration
- Supervise only care for which they have appropriate education, training, experience, or certification
Back-up physician coverage is not universally required. If you have one, the back-up
DEA Requirements / Application Process
The NP must have Board approval to practice and an individual DEA registration for North Carolina to prescribe any controlled substance. The NP’s DEA number must appear on each controlled-substance prescription.
Boards, Trade Associations & Authoritative Links
North Carolina Board of Nursing (NCBON) — Nurse Practitioner Practice
NCBON — Nurse Practitioner Collaborative Practice Guidelines
North Carolina Medical Board (NCMB)
NCMB Position Statement 9.1.1 — Physician Supervision of Other Licensed Health Care Professionals
N.C. Gen. Stat. § 90-18.2 (Limitations on Nurse Practitioners)
21 NCAC 36 .0810 (Quality Assurance Standards for a Collaborative Practice Agreement)
Disclaimer: This page for general informational purposes only and is not legal or medical advice. North Carolina requirements are set by state law and board rule and may change; consult your own counsel before relying on this information. CollabDocs facilitates physician-APC introductions and does not practice medicine or guarantee outcomes except as stated in a signed services agreement.
Reviewed by the CollabDocs Compliance Team | Last reviewed October 19, 2026
