North Carolina
PMHNP Practice Requirements In North Carolina: Scope, Prescribing & Collaboration
Short answer: AANP lists North Carolina as restricted practice, so a PMHNP practices under a collaborative practice agreement with a primary supervising physician, approved jointly by the Board of Nursing and the Medical Board, with monthly meetings for the first six months and at least every six months after (21 NCAC 36 .0804, .0810). Schedule II through V controlled substances may be prescribed as the agreement allows, under the NP’s own DEA number (21 NCAC 36 .0809).
North Carolina PMHNP Rules At A Glance
| Topic | North Carolina Rule |
|---|---|
| Practice authority | Restricted. An NP may not perform medical acts until registered, approved by both Boards and covered by a collaborative practice agreement with a primary supervising physician (21 NCAC 36 .0804; G.S. 90-18.2). |
| Physician agreement | Signed and dated by both, kept at each site, reviewed at least yearly with a signed sheet, listing the drugs, devices, treatments and procedures the NP may order, plus an emergency plan (21 NCAC 36 .0810(2)). |
| Physician limit | The NP rules set no number of NPs per physician; they require the primary or back up supervising physician and the NP to be continuously available to each other by direct communication or telecommunication (21 NCAC 36 .0810(1)). |
| Controlled substances | Schedules II through V may be prescribed as set in the agreement, on the NP’s own DEA number; the supervising physician must hold DEA schedules equal to or broader than the NP’s (21 NCAC 36 .0809(b)(2); G.S. 90-18.2). |
| PDMP | Before initially prescribing a targeted controlled substance and every three months after, review 12 months of NC Controlled Substances Reporting System data and document it; cancer, hospice and palliative care are excepted (G.S. 90-113.74C). |
| Regulator | North Carolina Board of Nursing and North Carolina Medical Board, acting through a Joint Subcommittee; applications go to the Board of Nursing and both Boards must approve (21 NCAC 36 .0804(e)). |
Updated October 5, 2026
Practice Authority
North Carolina Practice-Authority Category (Restricted Practice)
The American Association of Nurse Practitioners (AANP) currently classifies North Carolina as a restricted practice state on its State Practice Environment map. A PMHNP in North Carolina can’t practice fully independent of a physician relationship. Two boards are involved. Nurse practitioner approval to practice is handled jointly by the North Carolina Board of Nursing and the North Carolina Medical Board.
The AANP State Practice Environment map shows how North Carolina compares nationally. The rules you’re held to come from the North Carolina Board of Nursing and the North Carolina Medical Board.
Collaboration
Is A Collaborative Or Supervisory Agreement Required?
North Carolina generally requires an NP to have a supervising physician and a written collaborative arrangement, commonly documented as a collaborative practice agreement, before practicing. The Board of Nursing describes a registration step plus a separate approval-to-practice step reviewed jointly with the North Carolina Medical Board, and state rule sets what the agreement must contain, how supervision is documented and how often it’s reviewed.
Prescriptive Authority
Prescriptive Authority And Controlled Substances
Meet the requirements in North Carolina and you can be granted prescriptive authority, which can reach controlled substances once the conditions are met. For controlled substances you’ll also need your own federal DEA registration, and some substances carry additional conditions. The specific scope and documentation come from state law and board rule, with the U.S. Drug Enforcement Administration covering the federal side.
Next Step
Credentialing Is A Separate Track
Your North Carolina license and practice authority don’t enroll you with a single payer. Getting paid is a separate track, with its own payer rules, Medicaid program and enrollment timelines, and we cover it on the North Carolina credentialing and payer enrollment page. The PMHNP credentialing guide has the national picture.
Opening your own practice? Get licensure, collaboration and enrollment in the right order with our guide on how to start a PMHNP practice. When you get to the money, we’ve broken down what PMHNP credentialing costs and what it costs to start a PMHNP practice.
If you’d rather hand us the work, First Practice Launch sets up a first practice’s payers, EHR, portals and billing for $6,000, or four monthly payments of $1,500. Joining a clinic instead? New Provider Credentialing covers five commercial payers for $2,750 per provider, and you can start with one payer.
FAQ
Frequently Asked Questions
Can A PMHNP Practice Independently In North Carolina?
No. AANP lists North Carolina as restricted, and 21 NCAC 36 .0804 bars an NP from performing any medical act until the Board of Nursing and the Medical Board approve the application and a collaborative practice agreement with a primary supervising physician is in place. The approval ends when you stop working under that agreement, so each new practice setting means a new filing.
Do I Need A Collaborating Physician In North Carolina?
Yes, a primary supervising physician licensed by the Medical Board, with back up physicians allowed. The agreement must be signed by both, reviewed yearly, and backed by monthly meetings during the first six months and at least every six months after, with signed notes kept five years (21 NCAC 36 .0810). The two of you must stay continuously available to each other.
Can A PMHNP Prescribe Adderall In North Carolina?
Yes, if the collaborative practice agreement includes it. 21 NCAC 36 .0809(b)(2) allows Schedule II through V controlled substances as established in the agreement, using your own DEA number, and your supervising physician’s DEA registration must cover the same or broader schedules. G.S. 90-18.2 treats the prescription as authorized by the supervising physician.
This is general information, not legal advice. It applies the general nurse practitioner rules in North Carolina to PMHNPs. Rules change, so check with the North Carolina Board of Nursing, the North Carolina Medical Board, and the AANP State Practice Environment map before you act on it. Last reviewed: September 26, 2026.
Keep Reading
Related PMHNP Resources
Scope By State
Compare requirements across states on our PMHNP scope of practice by state overview.
Start A Practice
See the full sequence in how to start a PMHNP practice.
Credentialing
Learn what we handle on our PMHNP credentialing page, or visit the PMHNP hub.
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