Advanced Practice Registered Nurse License Requirements in North Carolina

North Carolina’s advanced practice nurses are licensed as RNs and registered as APRNs. The RN license may be held in North Carolina or in another compact member state, as delineated in the nurse compact ( APRN status is state and role specific.

North Carolina recognizes four advanced practice roles:

  • Nurse Practitioner (NP)
  • Certified Nurse Midwife (CNM)
  • Clinical Nurse Specialist (CNS)
  • Certified Registered Nurse Anesthetist (CRNA)

Requirements for clinical nurse specialists changed in July of 2015. Nurses in all four advanced specialties are now required to register with the Board.

Prospective advanced practice nurses must earn graduate degrees and, with few exceptions, pursue national certification in their specialty areas. They must maintain licensing. Both the licensing authority and the requirements vary from role to role (

Select a North Carolina Advanced Practice Registered Nurse Topic:

Nurse Practitioner Requirements

A prospective nurse practitioner must complete a master’s program that has nursing as its primary focus. The program is to be nationally accredited (Nurse Practitioner Programs in North Carolina).

A nurse practitioner may hold certification through any of the following organizations:

  • The American Academy of Nurse Practitioners (AANP)
  • The American Association of Critical Care Nurses (AACN)
  • The American Nurses Credentialing Center (ANCC)
  • The National Certification Corporation of the Obstetric Gynecological and Neonatal Nursing Specialties (NCC)
  • The Pediatric Nursing Certification Board (PNCB)

Nurse practitioners are under joint regulation by the North Carolina Board of Nursing and the North Carolina Medical Board. The Board of Nursing has provided links to laws and rules (

North Carolina NPs work under physician approval.

Approval is renewed annually.

Certified Nurse Midwife Requirements

Prospective nurse midwives must complete programs that qualify them as certification candidates by the American Midwifery Certification Board (AMCB). They must then pursue and maintain certification.

Nurse midwives are under the authority of the Joint Midwifery Committee. Rules are available online ( A North Carolina nurse midwife is to be supervised by a physician who practices obstetrics.

The Midwifery Joint Committee may grant Graduate Nurse Midwife Applicant status to a nurse midwife who has met education requirements but has not yet met examination requirements. There are some limitations on graduate practice. Graduate status is valid until the midwife is either approved for certification or notified of examination results (or up to a maximum of six months from the time of graduation).

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The Nurse Practitioner/Certified Nurse Midwife Application Process

Nurse practitioners and nurse midwives have collaborating physicians and must submit both registration and ‘approval to practice’ paperwork. Nurse practitioners will not necessarily complete these steps simultaneously. However, approval is necessary for practice. Both nurse midwives and nurse practitioners will need to file additional forms when work circumstances change.

Application is an online process. Applicants will begin by clicking their advanced practice category: nurse practitioner ( or nurse midwife (

A nurse midwife pays a $100 approval fee per physician.

A nurse practitioner pays $25 for registration and $100 for approval (if working in a non-volunteer capacity); the approval fee is reduced to $20 for NPs who work as volunteers.

Clinical Nurse Specialist Requirements

A prospective clinical nurse specialist must complete a degree program at at least the master’s level. The program is to be accredited by some agency recognized by the Council of Higher Education Accreditation (CHEA) or the U.S. Secretary of Education.

In most cases, a CNS must hold certification by an approved certification — CNS certifying agencies are not specified in administrative code. In cases where an otherwise qualified clinical nurse specialist has pursued a specialty for which there is no certification examination, the Board will consider alternate demonstration of competency. The clinical nurse specialist will need to demonstrate at least 1,000 hours of work experience. He or she will also be expected to demonstrate 75 CE contact hours earned during the prior five years.

A clinical nurse specialist who seeks alternative recognition will submit evidence such as curriculum vitae and letters of recommendation. The Board of Nursing has provided a flow chart illustrating the portfolio process (

A clinical nurse specialist who earned certification prior to 2007 and has maintained certification in the time since may be held to slightly different standards. He or she is still expected to hold a degree at the master’s level.

A clinical nurse specialist who has been out of practice for more than two years will be expected to take a refresher course before registration.

Certified Registered Nurse Anesthetist Requirements

A prospective CRNA will complete a master’s degree and a certification-qualifying nurse anesthetist program. The CRNA must hold certification through the National Board of Certification and Re-certification for Nurse Anesthetists (NBCRNA).

CRNA status is renewed biennially. The process is discussed in a document of frequently asked questions for CRNAs (–crna-recognition).

The Nurse Anesthetist/ Clinical Nurse Specialist Application Process

Nurse anesthetists and clinical nurse specialists are under the sole authority of the Board of Nursing. Applicants submit registration forms online.

CRNA ( and CNS ( forms can be accessed from the website of the Board of Nursing.

A CRNA pays $25 for state recognition; a CNS pays $25 for registration.

Additional Information

Advanced practice credentialing information is available from the North Carolina Board of Nursing ( The advanced practice contact person can be reached by telephone at 919-782-3211, Ext. 260. Applicants and licensees may direct email inquiries to the following addresses:
‘aprnapproval at’
‘aprnpractice at’
‘crna at’

The following organizations serve as additional professional resources:

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