Nurse Practitioner Cheat Sheet for Virginia
Requirements for Supervising Physician agreements in Virginia, plus a free agreement builder tailored to Virginia law.
Provider supervision requirements in Virginia
Updated 2026-08-12
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.
No provider type below has a codified chart-review percentage, countersignature rule, or numeric proximity radius — all are left to the practice agreement. CPOM (ownership) is governed by Title 13.1's PC/PLLC statutes, which explicitly list APRNs (NP/CRNA/CNM/CNS) as eligible independent owners but do not enumerate PAs — the PA ownership pathway is an inference from that omission, not a confirmed holding. Virginia has no independent corporate-practice-of-medicine common-law doctrine (a 1992 AG opinion, secondary-sourced only).
Nurse Practitioner
Independent practice requires: equivalent of ≥3 years full-time clinical experience — § 54.1-2957(I) itself only says 'as determined by the Boards,' but 18VAC90-30-86 defines full-time as 1,800 hours/year, i.e. 5,400 hours total (confirmed directly against the regulation text; a commonly-repeated secondary-source figure of ≈4,500 hours appears to be an error propagated across NP-advice sites); attestation from a patient care team physician who supervised the experience, or (per H.B. 971, eff. 7/1/2024) an 'attesting nurse practitioner' who has held autonomous-practice status ≥3 years
Autonomous-practice designation must be applied for and granted — it is not automatic upon hitting the hours threshold.
Proximity
Available remotely (no on-site requirement)
No codified mile/minute radius or on-site requirement; practice agreement need only address availability for routine and urgent consultation (§ 54.1-2957, 18VAC90-40-90).Chart review
Not codified — left to the practice agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Prescriptive scope (Schedules II–VI) must be specified in the practice agreement (§ 54.1-2957.01); autonomous-practice NPs prescribe within their own scope without agreement-based restriction.Practice ownership (CPOM)
Licensee-only ownership required — Professional Limited Liability Company (PLLC) under § 13.1-1102 — advanced practice registered nurses (APRNs, which includes NP) are explicitly listed as an eligible independent owner; no physician ownership required. Alternatively a Professional Corporation under § 13.1-543 with all shares held by licensed/authorized individuals.
NPs may independently own their own PLLC regardless of autonomous-practice status — this ownership pathway existed prior to, and is legally separate from, the § 54.1-2957 autonomous-practice clinical reform above.Supervision ratio
Up to 6 at a time
No more than 6 NPs per patient care team physician at any one time (18VAC90-40-90). Psychiatric-mental-health NPs have a separate, higher cap — see the dedicated `pmhnp` entry below rather than this general NP figure.Meeting cadence
Not codified — left to the practice agreement
Written agreement
Required
$600–$900/mo
Estimated NP supervision cost in Virginia
Available Supervising Physicians in Virginia
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