Collaborating Physicians in Tennessee: What NPs Need
Tennessee has no cap on how many nurse practitioners a physician can supervise — and that's the least useful fact about practising here.
Reviewed by Philip Wasef, MD — actively collaborating physician, licensed in 45 states including Tennessee. Last updated: September 2026.
What actually governs a Tennessee collaboration is the workload. Your supervising physician must personally review 20% of your charts every 30 days. And when you prescribe a controlled substance, they must personally review the historical, physical and therapeutic data within 10 days. The Board is explicit that the absence of a numeric cap doesn't mean a physician can take on unlimited providers — the number has to match their ability to actually perform those reviews. Which means Tennessee's real limit is the physician's calendar, not a number in a rule.
Quick Answers
Do Tennessee NPs need a collaborating physician?
Yes. Tennessee requires physician collaboration with a certificate of fitness and a filed notice and formulary. There is no independent practice pathway.
How much chart review is required?
At least 20% of charts monitored or written by the nurse practitioner, every 30 days.
What about controlled substances?
When a controlled drug has been prescribed, the physician must personally review the historical, physical and therapeutic data within 10 days, with certification added to the chart within 30 days.
How many NPs can one physician supervise?
There's no prescribed number. The Board's position is that the number must be consistent with the physician's ability to meet the chart review obligations. (Orthopaedic PAs are capped at two.)
Is there a distance limit?
No. Tennessee imposes no mileage rule. Your supervising physician must be available for consultation at all times, directly or through a designated substitute.
Can Tennessee NPs prescribe Schedule II?
Yes, Schedules II through V, using your own DEA number. Schedule II and III pain medications are limited to a non-refillable 30-day course of treatment unless specifically approved after consultation with your collaborating physician.
Do I need to register anywhere for controlled substances?
Yes. Registration with the Controlled Substance Monitoring Database is mandatory, and you must register your collaborating physician there within 30 days of establishing the relationship.
The review burden, and what it costs
Tennessee asks a lot of a supervising physician, and it asks it continuously.
Twenty percent of charts, every thirty days. For an NP seeing 25 patients a day, that's roughly 100 charts a month for the physician to personally review — every month, indefinitely.
Controlled substances on a ten-day clock. Every time you prescribe one, the physician personally reviews the historical, physical and therapeutic data within ten days. For a psychiatric practice, that isn't an occasional event. It's the rhythm of the work.
Tennessee prices above the middle, and this is why. It's not scarcity — there's no cap constraining supply. It's that a Tennessee collaboration is genuinely more work than most states', and physicians price the work. A rate meaningfully below market here should prompt the obvious question: at that price, who's doing the 20% and the ten-day reviews?
If the answer is nobody, the discount is the risk.
Get My Free Tennessee Quote
Tell us your patient volume and whether you prescribe controlled substances — both drive the review load, which is what a Tennessee physician is actually agreeing to.
Tennessee NPs with a certificate of fitness may prescribe Schedules II through V, using their own DEA registration.
But Schedule II and III pain medications are limited to a non-refillable 30-day course of treatment unless specifically approved after consultation with the collaborating physician.
Two practical points.
The limit is on pain medications, not all of Schedule II. Stimulants are Schedule II but fall outside it, so the 30-day cap doesn't reach them — the general chart review obligations still do.
The exception requires a consultation, not a standing permission. "Specifically approved after consultation" means a conversation about that patient, not a clause in your agreement authorising longer courses in general. Agreements that try to pre-authorise this are papering over something the statute expects to happen case by case.
The Tennessee process, step by step
Check your certificate of fitness status. If you're applying fresh, the application goes through the state licensing portal (LARS), and includes an official transcript from the institution where you completed your education. If you already hold an active certificate, this isn't a step you repeat for each new collaboration.
Submit your application through LARS.
Notify your collaborating physician once you've submitted, so they can complete their side of the approval online. This is the smoother route — the physician accepts your collaboration request through the portal.
Alternatively, submit a completed and signed Notice and Formulary form directly. This is a mail-in submission, which is why the online route in step 3 is usually better. The notice names you and the collaborating physician who has control and responsibility for prescriptive services, and the formulary sets out the categories of drugs you may prescribe.
Draft, review and sign the collaborative agreement, and keep a signed copy at the practice site.
Update your Mandatory Practitioner Profile within 30 days of the collaboration taking effect — and again within 30 days of any future change. NPs who prescribe must keep supervising or collaborating physician information current within 30 days of a change. This is done through LARS.
Register your collaborating physician with the Controlled Substance Monitoring Database within 30 days of establishing the relationship.
Set up the review cadence before you start seeing patients — 20% monthly, controlled substances within 10 days. Agreeing the mechanics on day one is what keeps this from silently lapsing.
What a collaborating physician costs in Tennessee
Tennessee runs slightly above the middle, and the reason is the review burden rather than scarcity.
Most states price on supply — a cap limits how many physicians are available and the price rises against that ceiling. Tennessee has no cap. What it has instead is a review obligation that makes each collaboration a real recurring commitment: 20% of charts every month, plus controlled substance reviews on a ten-day clock.
Physicians price that honestly, and you should want them to. The cheap Tennessee quote is cheap because one of those two things isn't happening.
At MD-Match, pricing is tailored to your practice rather than flat-rated. The match fee is $50, one time, and rematching is free, always.
Mistakes I actually see in Tennessee arrangements
Assuming the absence of a cap means a physician has room.
The Board ties the number to the physician's ability to perform the reviews. A physician carrying a dozen NPs may be non-compliant while technically within a limit that doesn't exist. Ask how many they currently supervise, and how they handle the 20%.
Letting the ten-day controlled substance review slip.
It's the tightest clock in the arrangement and the easiest to miss, because it's triggered by your prescribing rather than by a calendar.
Pre-authorising longer courses in the agreement.
The exception requires consultation about the patient, not a general clause.
Forgetting the 30-day profile update.
It applies when the collaboration starts and on every change afterwards. Nothing prompts it.
Not registering the collaborating physician with the CSMD.
Separate 30-day obligation, easy to overlook because it feels like it should be part of the LARS filing.
Doing the Notice and Formulary by mail when the physician could accept online.
Slower, and mail-in submissions are where things get lost.
Every physician in the MD-Match network is background-checked, license-verified for Tennessee, and capacity-checked before matching — which in Tennessee means confirming they can actually carry the review load for your volume, not just that they're under a cap that doesn't exist. We build the 20% monthly review and the ten-day controlled substance clock into the arrangement as scheduled obligations with reminders, because in Tennessee those two things are the arrangement.
How MD-Match works in Tennessee
Complete the free intake form — credential, specialty, practice setting, timeline. First step takes about two minutes.
Get a personalized quote. I review every Tennessee submission myself. Tell me your patient volume and whether you prescribe controlled substances — both drive the review load, which is what a Tennessee physician is actually agreeing to.
Pay the one-time $50 match fee and get matched with a Tennessee-licensed, specialty-aligned physician who can realistically carry the review obligations at your volume.
We handle the compliance rails — the LARS filing, the Notice and Formulary, the collaborative agreement, the 30-day profile update, CSMD registration of your physician, and review scheduling. If a match stops working, rematching is free.
Get My Free Tennessee Quote — 2-Minute First Step
Pricing is tailored to your practice, not flat-rated. The match fee is $50, one time, and rematching is free, always.
Yes. Tennessee requires a certificate of fitness and a filed notice and formulary naming the collaborating physician who has control and responsibility for prescriptive services.
The supervising physician must personally review at least 20% of charts monitored or written by the nurse practitioner every 30 days.
When a controlled drug has been prescribed, the physician must personally review the historical, physical and therapeutic data within 10 days, with certification added to the chart within 30 days.
There is no prescribed number. The number must be consistent with the physician's ability to meet the chart review obligations. Orthopaedic physician assistants are capped at two.
No. Tennessee imposes no mileage rule. The supervising physician must be available for consultation at all times, directly or through a designated substitute.
The Board's rules provide for the supervising physician to visit a remote practice site at least once every 30 days. In practice, enforcement of this provision has been limited. It's worth discussing with your collaborating physician when you set the arrangement up, so you both know where you stand.
Yes, Schedules II through V using the NP's own DEA registration. Schedule II and III pain medications are limited to a non-refillable 30-day course of treatment unless specifically approved after consultation with the collaborating physician.
A filing naming the nurse practitioner and the collaborating physician responsible for prescriptive services, together with a formulary describing the categories of drugs the nurse practitioner may prescribe.
Within 30 days of the collaboration taking effect, and within 30 days of any subsequent change.
Yes. Practitioners who must maintain collaborating physicians are required to register them with the Controlled Substance Monitoring Database within 30 days of establishing the relationship.
Philip Wasef, MD is the founder of MD-Match and an actively practicing collaborating physician licensed in 45 states, including Tennessee. This page describes regulatory requirements in general terms and is not legal advice; requirements change and your situation may vary. Verify current rules with the Tennessee Board of Nursing and the Tennessee Board of Medical Examiners, or ask us.