PMHNP Practice Authority in Tennessee: Independence, Physician Agreements and Schedule II

AANP's May 2026 map puts Tennessee in its restricted tier.

The legal fact behind the label is Board of Nursing rule 1000-04-.04(6): an APRN with a certificate of fitness who prescribes must have a collaborating physician who complies with the Board of Medical Examiners' collaboration rule, or the Board of Osteopathic Examiners' counterpart, jointly adopted by the boards.

Before prescribing, the APRN files a notice with the Board naming the collaborating physician who has control and responsibility for prescriptive services, plus a copy of the formulary of legend drugs.

The rule chapter was reissued effective October 8, 2024, so this is the current structure.

None.

Collaboration is career-long: no hour total, no years-in-practice threshold, and no certificate or registration that ends it.

A new graduate and a PMHNP with twenty years of experience file the same notice, name a collaborating physician, and work under the same chart-review rules.

The one reduced-status credential, the temporary certificate of fitness, moves in the opposite direction — it is for RNs who have applied for the national certification examination or are awaiting its results as first-time examinees, and it requires supervision by a certified nurse practitioner or physician, so nothing a Tennessee PMHNP accrues unlocks independence.

The collaborating physician's own board rule (0880-06-.02, last amended effective August 22, 2004) sets the mechanics.

Protocols are jointly developed and reviewed and updated biennially.

Once every ten (10) business days the physician must personally review the historical, physical and therapeutic data and certify by signature within thirty (30) days in five circumstances — including when a controlled drug has been prescribed, the limb a PMHNP hits most often.

At least 20% of charts are personally reviewed every thirty (30) days, and any remote site is visited at least once every thirty (30) days; up to ten (10) of the annual remote site visits may be by HIPAA-compliant electronic means (the statute defines "annual" as a rolling twelve-month period), and community mental health center and FQHC APRNs may do chart review and site visits electronically.

Choosing a supervisor: the rule requires experience or expertise in the same area of medicine as the nurse practitioner, available for consultation at all times or with a substitute arranged.

No cap on APRNs per physician was located.

The statute authorizes a certificate-of-fitness nurse practitioner to prescribe controlled substances listed in Schedules II–V of title 39, chapter 17, part 4 upon the jointly adopted physician collaboration rules — so an outpatient Tennessee PMHNP can prescribe Schedule II ADHD stimulants.

The gate is subdivision (b)(2)(B): every Schedule II, III or IV prescription must be specifically authorized by the formulary, or the drug must be expressly approved after consultation with the collaborating physician before that prescription is first issued or dispensed.

The 30-day limit in (b)(2)(C) is opioid-specific: a Schedule II or III opioid listed on the formulary may be prescribed only for a maximum of a non-refillable, thirty-day course of treatment unless pre-approved after consultation, and the cap does not apply in a hospital, a nursing home licensed under title 68, or inpatient facilities licensed under title 33.

It does not limit stimulants.

Prescriptions must be written on pads bearing the collaborating physician's name, and the APRN maintains a DEA registration at the practice location.

A separate state controlled-substance registration was not located in the sources read.

Board rule 1000-04-.08 makes it a prima facie violation to prescribe without a documented history and physical examination, a diagnosis based on the examination and diagnostic tests, a therapeutic plan discussed with the patient, and the APRN's own availability or coverage for the patient for appropriate follow-up care.

Paragraph (2) excepts prescribing consistent with sound judgment; its examples are admission orders for a newly hospitalized patient, a patient of a prescriber the APRN is taking calls for or whose medication appropriateness the APRN has verified, short-term continuation medications for a new patient before the first appointment, and established patients who, based on sound practices, the APRN believes do not require a new physical examination — that is, new stimulant prescriptions for established patients.

Subdivision (3) carries the same exception: no prescribing from a set of questions alone, however issued.

Federally, the DEA registers the PMHNP as a mid-level practitioner, and that registration covers only what Tennessee allows; the DEA and HHS telemedicine flexibilities (through December 31, 2026) remove the federal in-person evaluation requirement but lift no Tennessee condition.

Tennessee has not enacted the APRN Compact.

The compact comes into effect only when seven states enact it, and five had as of September 2026 (Delaware, North Dakota, South Dakota, Utah and Wyoming), so no APRN holds a multistate APRN licence today.

The Nurse Licensure Compact is an RN compact and confers no nurse practitioner authority — though Tennessee's own certificate-of-fitness rule accepts a current RN license with the multistate licensure privilege to practice in Tennessee as the registered-nurse layer, so the RN licence can travel while the APRN certificate, the certificate of fitness and the collaborating physician remain Tennessee's own.

Board of Nursing rule chapter 1000-04 was repealed and rewritten, filed July 10, 2024 and effective October 8, 2024, so the certificate-of-fitness and prescribing-prerequisite rules carry recent effective dates.

The collaboration mechanics are the opposite: 0880-06-.02 was last amended effective August 22, 2004, and still says "supervising physician" where the nursing rule and the statute say "collaborating physician".

Two caveats for reliance: the § 63-7-123 text read is a FindLaw mirror marked last updated January 2, 2024, so 2025–2026 amendments would not show in it, and 2025 bills were not located in the sources read — check the General Assembly before assuming the statute stands unchanged.