Virginia
PMHNP Practice Requirements In Virginia: Scope, Prescribing & Collaboration
A Virginia PMHNP works under a written or electronic practice agreement with a patient care team physician until completing the equivalent of three years of full-time clinical experience (5,400 hours) and receiving a license with the autonomous practice designation. You can prescribe Schedule II through VI drugs within that agreement, and before you start a patient on an opioid expected to last more than seven consecutive days, you have to check the Prescription Monitoring Program.
| At A Glance | Virginia |
|---|---|
| Practice Authority | Restricted practice (AANP), with a path to autonomous practice under Va. Code § 54.1-2957(I). |
| Physician Agreement | Written or electronic practice agreement with at least one patient care team physician until you hold the autonomous practice designation (§ 54.1-2957(C)). |
| Transition To Practice | The equivalent of three years of full-time clinical experience. 18VAC90-30-86 counts 1,800 hours a year, so 5,400 hours. |
| Controlled Substances | Schedules II through VI. Without the designation, only what your practice agreement authorizes (§ 54.1-2957.01). |
| PMP | Registration required. Check before starting an opioid expected to last more than seven consecutive days (§ 54.1-2522.1). |
| Regulator | Virginia Boards of Nursing and Medicine. |
Updated September 26, 2026
Practice Authority
Virginia Practice-Authority Category (Restricted Practice, Path To Autonomous)
Verified against AANP on September 26, 2026. Earlier versions of this page listed Virginia as reduced practice.
The American Association of Nurse Practitioners (AANP) classifies Virginia as a restricted practice state. Under Va. Code § 54.1-2957(C), every nurse practitioner who hasn’t met the autonomous practice requirements keeps collaboration and consultation with at least one patient care team physician, set out in a written or electronic practice agreement. Subsection I is the way out of that agreement, and it’s explained below.
Collaboration
Is A Collaborative Or Supervisory Agreement Required?
Yes, until you hold the autonomous practice designation. Va. Code § 54.1-2957(D) says the practice agreement has to provide for periodic review of health records, which can include visits to the site where care is delivered, in the manner and at the frequency you and the patient care team physician decide. It also has to provide for input from other providers on complex cases, emergencies and referrals. If the agreement covers prescribing, § 54.1-2957.01 requires it to state which controlled substances you can or can’t prescribe.
Autonomous Practice
When Can A Virginia NP Practice Without A Practice Agreement?
After the equivalent of at least three years of full-time clinical experience (Va. Code § 54.1-2957(I)). The Board of Nursing rule, 18VAC90-30-86, counts full time as 1,800 hours a year, and the Board notes the requirement was reduced to three years, or 5,400 clinical hours, in July 2024. You apply with an attestation from your patient care team physician, or from an attesting nurse practitioner who has met the autonomous practice requirements for at least three years. The Boards then issue a new license with a designation that you’re authorized to practice without a practice agreement. From then on you practice within your training, consult and collaborate with other providers as each patient’s condition requires, and keep a plan for referring complex cases and emergencies.
Prescriptive Authority
Prescriptive Authority And Controlled Substances
Virginia nurse practitioners can prescribe Schedule II through Schedule VI controlled substances and devices (Va. Code § 54.1-2957.01). Until you hold the autonomous practice designation, you can prescribe them only as your practice agreement authorizes, and the agreement has to list the controlled substances you’re authorized or not authorized to prescribe. You also have to tell patients at the first visit that you’re a licensed advanced practice registered nurse. You’ll still need your own federal DEA registration, and the U.S. Drug Enforcement Administration covers that side.
PMP
Virginia Prescription Monitoring Program Rules
Any prescriber licensed in Virginia to treat human patients and authorized to prescribe a covered substance has to be registered with the Prescription Monitoring Program (Va. Code § 54.1-2522.1). Under the version in force until July 1, 2027, you request PMP information when you start a new course of treatment that includes an opioid expected to last more than seven consecutive days, to see what other covered substances the patient gets and whether they’ve had an opioid overdose. The version that takes effect July 1, 2027 changes that trigger to a benzodiazepine or an opiate expected to last more than 90 consecutive days. Hospice and palliative care patients and inpatient hospital admissions are among the exceptions.
Next Step
Credentialing Is A Separate Track
Practice authority decides what you can do in Virginia. It doesn’t get you paid. Payer enrollment runs on its own track, with its own payer rules, Medicaid program and timelines, and our Virginia credentialing and payer enrollment guide covers it. For the national picture, read the PMHNP credentialing guide.
If you’re opening your own practice, order matters. Our guide on how to start a PMHNP practice walks through licensure, collaboration and enrollment in sequence.
Budgeting for the move? See what PMHNP credentialing costs and what it costs to start a PMHNP practice. If you’d rather hand us the setup, First Practice Launch covers a first practice’s payers, EHR, portals and billing for $6,000, or four monthly payments of $1,500.
FAQ
Frequently Asked Questions
Is Virginia A Full Practice Authority State For PMHNPs?
Not automatically. AANP classifies Virginia as restricted practice. You work under a written or electronic practice agreement with a patient care team physician until you’ve completed the equivalent of three years of full-time clinical experience, which Board rules count as 5,400 hours, and the Boards issue you a license with the autonomous practice designation (Va. Code § 54.1-2957(I)).
Do I Need A Collaborating Or Supervising Physician In Virginia?
Until you hold the autonomous practice designation, yes. Va. Code § 54.1-2957(C) requires a written or electronic practice agreement with at least one patient care team physician. Subsection D has the agreement provide for periodic review of health records, in the manner and at the frequency you and the physician decide, plus input from other providers on complex cases, emergencies and referrals.
Can A PMHNP Prescribe Controlled Substances In Virginia?
Yes. Va. Code § 54.1-2957.01 covers Schedules II through VI. Without the autonomous practice designation, you prescribe only what your practice agreement authorizes, and the agreement lists the controlled substances you can or can’t prescribe. You’ll need your own DEA registration, and before starting an opioid expected to last more than seven consecutive days, you have to check the Prescription Monitoring Program.
How Long Before A Virginia NP Can Practice Autonomously?
The equivalent of three years of full-time clinical experience. Board rule 18VAC90-30-86 defines full time as 1,800 hours a year, so 5,400 hours in all, and the requirement was reduced to three years in July 2024. You apply with an attestation from your patient care team physician or a qualifying attesting nurse practitioner, and the Boards issue a new license with the designation.
References
Official Virginia Sources
- Va. Code § 54.1-2957, practice agreements, health record review and autonomous practice, checked October 4, 2026.
- Va. Code § 54.1-2957.01, prescribing Schedules II through VI under a practice agreement, checked October 4, 2026.
- 18VAC90-30-86, 1,800 hours a year as full-time clinical experience, checked October 4, 2026.
- Virginia Board of Nursing, Advanced Practice Registered Nurse, three years or 5,400 hours since July 2024, checked October 4, 2026.
- Va. Code § 54.1-2522.1, Prescription Monitoring Program registration and checks, checked October 4, 2026.
This is general information, not legal advice. It applies the general nurse practitioner rules in Virginia to PMHNPs. Rules change, so check with the Virginia Board of Nursing and the AANP State Practice Environment map before you act on it. Last reviewed: September 26, 2026.
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See what we handle on our PMHNP credentialing page, or the PMHNP hub.
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