Nurse Practitioner Cheat Sheet for Missouri
Requirements for Supervising Physician agreements in Missouri, plus a free agreement builder tailored to Missouri law.
Provider supervision requirements in Missouri
Updated 2026-09-03
Provided for educational and research purposes only — this is not legal advice. Laws and regulations change frequently, and this content may contain errors or omissions. Always confirm current requirements with a licensed attorney before relying on this for compliance decisions.
PA/APRN collaboration is governed by nearly-identical §§ 334.104/334.735: a 6-FTE combined ratio cap, 10%/20% chart-review every 14 days, biweekly physician presence, and a 120-hour controlled-substance Rx cap. A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Nurse Practitioner
Missouri has no full-independent-practice tier for APRNs — a written collaborative practice arrangement is mandatory for as long as the NP practices (§ 334.104). The often-cited '1,000 hours' figure only gates a controlled-substance prescriptive-authority certificate — it does not end collaboration.
Proximity
Available remotely (no on-site requirement)
§ 334.104 requires the collaborating physician and APRN to 'maintain geographic proximity,' with no numeric mileage in the current statutory text (a pre-2024 75-mile rule was reportedly rescinded — secondary-sourced, verify before relying on it). A statutory correctional-center exception permits 200 miles by road, but that carve-out's sunset date (August 28, 2025) has already passed as of this writing — its current status is unconfirmed. Rural health clinics may waive proximity up to 28 days/year; telehealth arrangements in shortage areas reportedly waive it further (secondary-sourced).Chart review
10% of charts · As needed (every 14 days)
10% of all charts, every 14 days (§ 334.104); 20% for controlled-substance charts.Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Same Schedule III/IV/V plus Schedule II hydrocodone framework as `pa`, 120-hour cap (30 days for buprenorphine). Requires ≥1,000 hours of practice in the applicable APRN category (secondary-sourced figure, not independently re-verified against current rule text) before applying for the controlled-substance certificate — this threshold gates the Rx certificate only, not exit from the collaborative practice arrangement itself.Practice ownership (CPOM)
Licensee-only ownership required — As for PAs: RSMo Chapter 356 professional corporations with licensed shareholders
Supervision ratio
Up to 6 at a time (combined cap across provider types)
Shares the same 6-FTE combined cap (APRNs/PAs/assistant physicians together) as the `pa` entry (§ 334.104).Meeting cadence
As needed
Physician presence at least once every 2 weeks for chart review/medical direction (§ 334.104). Separately, a new APRN must complete a minimum one-month period of practice with the collaborating physician continuously present before working with reduced/periodic presence — this is an onboarding step, not a path to full independence; the biweekly-presence and chart-review rules continue indefinitely afterward.Written agreement
Required
$700–$1,100/mo
Estimated NP supervision cost in Missouri
Available Supervising Physicians in Missouri
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