How to Open a Nurse-Owned Practice in Missouri

You've done the math in your head more than once. A few injectable appointments on your day off, on your own schedule, in your own space, and suddenly the shifts you pick up out of obligation start to look optional. Kansas City and St. Louis give Missouri two metro markets where cash-pay aesthetics is already normal in suburbs like Lee's Summit, Chesterfield, and O'Fallon, and Springfield and Columbia are big enough to fill a book without big-city rent. (Already run your own practice? Skip ahead, there's a section below built specifically for you.)

The thing that stops most nurses in Missouri was never the clinical work. You already do harder things on a Tuesday than a first tox or IV appointment will ever ask of you. What stops people is everything around it, the ownership rules, the medical director, the setup, all sitting there as one giant undefined to-do. So let's take it in order, starting with the question every Missouri nurse asks first.

Can a nurse own an aesthetics, wellness, or functional health practice in Missouri?

Yes. Missouri does not have a corporate practice of medicine doctrine (State ex inf. McKittrick v. Gate City Optical Co., 97 S.W.2d 89, 1936). A nurse-owned LLC can operate the practice and contract with a medical director without a professional corporation. Your own license covers the work: "the administration of medications and treatments as prescribed by a person licensed by a state regulatory board to prescribe" (RSMo 335.016(16)).

The Missouri rule that catches almost everybody: your NP director comes with a physician attached

Missouri isn't a full practice state. An APRN prescribes only under a collaborative practice arrangement with a physician (RSMo 334.104). The famous 75-mile rule is gone: after the statute was amended effective August 28, 2023, the boards rescinded the mileage definition, and the current rule (20 CSR 2200-4.200, amended July 30, 2024) has no distance in it. The Board of Nursing's own web page still shows the old 30-mile and 50-mile language, which is a stale page and not the law, and yes, it trips people up.

What's still in the statute matters for your director. The pair must maintain geographic proximity unless the arrangement outlines the use of telehealth. The APRN spends a month practicing with the physician continuously present before working apart, submits at least 10 percent of charts for review every 14 days, and no physician can collaborate with more than six full-time-equivalent APRNs, PAs, and assistant physicians combined (RSMo 334.104). None of it puts anyone in your treatment room, and all of it has to be current before your NP signs your first order.

Can an APRN be your medical director in Missouri?

Yes, with the arrangement above in place. A physician director skips it, and Missouri has no medical spa rule and no on-site requirement for physician delegation to an RN. The one line a physician has to respect is the discipline statute, which makes it unprofessional conduct to delegate to someone "not qualified by training, skill, competency, age, experience or licensure" (RSMo 334.100.2(4)(d)).

The initial patient evaluation in Missouri

Missouri doesn't call it a good faith exam. A prescriber establishes a relationship that includes a reliable medical history, a physical exam if the standard of care requires one, a real discussion of options and risks, and a contemporaneous record (RSMo 334.108). That relationship can be created by telehealth "if the standard of care does not require an in-person encounter," and a questionnaire the patient fills out alone does not count (RSMo 191.1146).

One that surprises people: Missouri LLCs file no annual report. Ever. The Secretary of State's FAQ answers it with one word: "No."

How Five Square actually gets you started

The whole thing lives in one place: the free Five Square Nurses app. Your medical oversight, the step-by-step training, your pharmacy and vendor accounts, and the entire community of nurse business owners are all in there. You can open it between patients, on a lunch break, or on the couch at 9pm, and pick up right where you left off.

When you join, you're not handed a login and wished good luck. There's a Getting Started path that puts the order of operations right in front of you, so the mountain becomes a checklist.

You pick your lane, or combine them. Five Square supports three:

• Aesthetics. Tox and dermal filler, the core of a nurse-injector practice, with room to add more as you train.
• Wellness. IV therapy and vitamin injections. Low startup, very mobile-friendly, and a natural add-on to aesthetics.
• Functional Health. Peptides, lab work, and whole-person care for nurses who want longer-term, relationship-based patients.

You bring the nursing license and the nerve. We bring the medical director, the compliant Missouri setup, the training, member pricing on products, marketing help, and weekly live calls with experts and other nurse owners, so you're never stuck guessing alone.

And every Five Square member, brand new or already established, gets instant on-demand Good Faith Exams for $19.99 each, a price we subsidize because we believe in nurse success. A walk-in can be cleared in about a minute, seven days a week, and the exam paperwork lands right in the patient's chart, which is exactly what a state board wants to see.

You start before you feel ready, and that's the point

Most programs make you wait. Watch every module, sit through every call, and someday you finally see a patient. By then half the people who started have lost momentum. Five Square runs the other way: you start your practice while you're still finishing the training, because the training sticks when there's a real patient on next week's calendar.

Kayla, an ER nurse in North Carolina, had never injected anyone when she joined. She watched the videos, took notes, and set a goal of 30 people in 30 days. Here's the advice she'd give a nurse who's scared to start:

"Believe in yourself, even when you don't know how to do something. Figure it out. The clinical knowledge from your nursing career is more than enough to get started, and there's a community of people around you who want to help. Do it scared."
- Kayla, ER nurse

She launched April 4. Her first month: 46 appointments, 28 good-faith exams, and $10,320 in revenue, run out of a single room inside a salon she'd been a client at for years. That's one real month from one real nurse, not a typical result and not a promise, and your market and hours are your own. The point is she was exactly where you are, never-done-this-before, and she started anyway.

Does it actually work once you launch?

Getting launched is step one. What you really want to know is whether it works after that. Here's the honest picture, numbers included, because income claims in this industry deserve a skeptical read.

Results vary, and they depend on things no membership controls: your market, your hours, how long you've been at it, how consistently you market. As practices mature, some established members report months in the $10,000 to $20,000 range. Individual results vary widely. Some land higher, some lower, and nobody here will promise you a number.

What's more useful is the math underneath, which is public. Neurotoxin appointments bring in $200 to $600. A syringe of filler runs $500 to $800. IV sessions run $150 to $350. Functional health consults run $150 to $300, often with patients coming back monthly. At those prices, two to four appointments a month would cover the $899 membership before product costs, and everything past that is the business growing. Want to see it with your own pricing? Run your numbers in the Five Square membership earnings calculator.

The nurses say it better than a revenue range does:

"The support is unreal. I did my first lip fillers and felt completely confident thanks to the training and the team."
- Tammi B., RN

"I started with Five Square last spring and they've helped me every step of the way. Trainings, weekly meetings, check-ins. An abundance of resources to actually make you successful."
- Kendra P., 5-star Google review

Inside the community, the wins show up in real time. A nurse a few weeks into her launch posted she was already up to eight bookings, nearly all of it from one post in a local mom's Facebook group. Another saw a husband and wife for their good-faith exams in under ten minutes using the same-day exam tool when her director wasn't free. Scroll the forum any week and it's full of small wins like these.

The Google rating sits at 4.8 stars, and the reviews keep naming the same things: the setup help, the medical director, the training, and a team that answers when you're stuck.

Already run a practice in Missouri? There's a membership for that too

Not every nurse reading this is starting from scratch. Plenty of you already run your own practice and already pay for a medical director somewhere. If that's you, a lot of what's above is stuff you sorted out a while ago, and Five Square has a leaner membership built for exactly your spot. Missouri is on the Five Square expansion roadmap, and in most new states the Established Nurse Membership opens first, so if you already run a practice, you're likely first in line.

It's called the Established Nurse Membership. It's $799 a month, month to month, no annual lock. You get a medical director who's actually engaged, a compliant structure in Missouri, vendor and product pricing, the Five Square Nurse Community, and those instant on-demand Good Faith Exams at $19.99 each, a price we subsidize for our members because we believe in nurse success. There's no new-injector training folded in, because you don't need it and shouldn't pay for it. If you ever want the full education stack later, you can add it.

Here's the honest pitch. Most established practices are either paying $1,500 to $5,000 a month for a director who's genuinely involved, or a few hundred for one who signs protocols and disappears, which is its own risk when a board comes asking. For most nurses, $799 all in beats both, on price and on what you actually get. Tell us what you're paying now and we'll show you the side by side. No pitch, just the math.

What it costs, and the catch nurses look for

For a nurse starting out, membership is a flat $899 a month for one tier, $1,199 for two, $1,499 for all three, on a 12-month term. Startup beyond that is lighter than people expect: a starter tox order, insurance that runs well under most nurses' guesses, and the products you actually use. No revenue share, ever. (Already have a practice? The Established Nurse Membership above is $799 a month, month to month.)

That's usually the moment the skeptical part of your brain asks where the catch is. Fair. So, plainly: you own your practice and your patients through your own LLC. Five Square does not take a cut of what you make, and if a discovery call turns up that the honest answer for you is 'not yet' or 'start smaller,' the team will tell you that too.

Missouri-specific costs to budget for

Filing Articles of Organization with the Missouri Secretary of State is $50 online or $105 on paper, and that's close to the whole state bill, because Missouri LLCs don't file an annual report. If you sell skin care or supplements to patients, Missouri's state sales tax is 4.225 percent, and local rates in Kansas City, St. Louis, and their suburbs stack on top, often landing between 8 and 10 percent, so register for a sales tax license with the Department of Revenue before your first retail sale. Keep in mind the Secretary of State adds a $5 technology fee to filings through the end of 2026.

So, where do you actually start in Missouri?

You book the call. That's genuinely it. Not a six-month research project, a 15-minute conversation about your license, your goals, and what launching (or leveling up) in Missouri would look like for you. Whether you're brand new or already running a practice, the whole reason Five Square exists is so you're not doing the hard parts alone.

Schedule a discovery call

Common questions about starting a practice in Missouri

Did Missouri really get rid of the 75-mile rule for nurse practitioners?

Yes. The statute was amended effective August 28, 2023, the Board of Registration for the Healing Arts voted in January 2024 to rescind the mileage definition, and the current collaborative practice rule (20 CSR 2200-4.200, amended July 30, 2024) contains no distance requirement. The statute still asks a collaborating pair to maintain geographic proximity unless their arrangement outlines the use of telehealth (RSMo 334.104). If your NP director's arrangement is written that way, distance stops being the issue.

Can the initial patient evaluation be done by telehealth in Missouri?

It can, when the standard of care allows it. Missouri lets a provider establish the patient relationship through a telemedicine encounter if the standard of care does not require an in-person visit, using technology sufficient to reach an informed diagnosis as if the evaluation had been done in person (RSMo 191.1146). A questionnaire alone doesn't count as an exam. The provider still has to take a reliable history and keep a contemporaneous record (RSMo 334.108).

Can an LPN inject Botox or run IVs in Missouri?

The Missouri Board of Nursing hasn't published a position on cosmetic procedures. The statute says an LPN gives care "under the direction of" a prescriber or an RN, and defines direction as orders that can be communicated without direct physical oversight (RSMo 335.016(15)). That's a framework, not a green light. Before you hire an LPN to inject, get the question in front of the board in writing and keep the answer in your compliance file.

Can a registered nurse own a med spa in Missouri? Yes. Missouri does not have a corporate practice of medicine doctrine (State ex inf.

Do I need a medical director for aesthetics in Missouri? Yes. Missouri requires oversight for medical aesthetic services, and every Five Square practice includes a medical director as part of the membership.

Can a nurse do Botox in Missouri? Yes, within a compliant setup and with the oversight Missouri requires. The question is rarely whether a nurse can do the work; it's whether the practice around it is set up right.

I already run a practice in Missouri. Can Five Square still help? Yes. The Established Nurse Membership is built for nurses who already have a practice: $799 a month, month to month, with a medical director, a compliant structure, vendor pricing, and $19.99 on-demand Good Faith Exams. No new-injector training you don't need, and no annual lock.

How much are Good Faith Exams? For Five Square members, simple Good Faith Exams are $19.99 each, on demand, seven days a week, a price we subsidize because we believe in nurse success. One exam can clear a patient for several treatments at once, and the documentation attaches right to the patient's chart.

Is Five Square available in Missouri yet? Missouri is on the Five Square expansion roadmap, and in most new states the Established Nurse Membership opens first. The fastest way to get the timeline and hold your spot is a discovery call.

How much does it cost to start? For a new nurse, membership is $899 a month for one tier, and startup beyond that (a tox order, insurance, products) is lighter than most nurses expect. If you already run a practice, the Established Nurse Membership is $799 a month, month to month. No revenue share either way.