How to Open a Nurse-Owned Practice in North Carolina

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. North Carolina keeps adding people faster than it adds injectors, from the Triangle and Charlotte out to the coast and the mountains. Plenty of those new neighbors already pay out of pocket for tox and a vitamin drip and haven't found their person yet. (Already run your own practice? Skip ahead, there's a section below built specifically for you.)

The thing that stops most nurses in North Carolina 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 North Carolina nurse asks first.

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

Yes, with the right setup. An RN can own the practice outright in North Carolina, through a professional entity. Nursing is a listed professional service (N.C. Gen. Stat. §55B-2(6)), a PLLC may be formed by "any combination of a registered nurse, nurse practitioner" and other advanced practice nurses "to render nursing and related services" (N.C. Gen. Stat. §55B-14(c)(2)), and every owner has to be a licensee, meaning an RN for a nursing PLLC (N.C. Gen. Stat. §55B-4(2); 21 NCAC 36 .0501(b)(3)).

The North Carolina rule that catches almost everybody: the Board of Nursing comes before the Secretary of State

In most states you file the LLC and move on. Here a nursing PLLC gets registered with the Board of Nursing first: apply through the Nurse Portal, pay $50, and the Board issues a Certificate of Registration that gets filed with the Secretary of State along with your articles (21 NCAC 36 .0500 and .0600). Renewal is $25 by December 31, and 30 days late means automatic suspension. Nurses who form the LLC first end up doing it twice.

The entity also has a lane: "only one specific type professional service" (N.C. Gen. Stat. §55B-14(a)), nursing in your case. The Medical Board enforces the corporate practice of medicine hard (NCMB Position Statement 10.1.2, amended September 2025), so the medical director is engaged alongside the nursing entity, never folded into it.

Who can be your medical director in North Carolina

A physician, an NP, or a PA can be the ordering provider for injectables (NCBON cosmetic position statement). North Carolina isn't a full practice authority state, so an NP works under a Collaborative Practice Agreement with a supervising physician who's continuously available by phone, nobody on site (21 NCAC 36 .0810). The wrinkle: a new CPA means monthly NP-physician meetings for the first six months, then at least every six months, documented and kept five years. A physician director skips that.

The initial patient evaluation

North Carolina doesn't call it a good faith exam. A physician, NP, PA, or other practitioner with prescriptive authority "must complete client evaluation/assessment for procedure appropriateness and issue a prescription/order" before you inject. You carry out the order; you don't write it. Telehealth works if the standard of care is met (NCMB Position Statement 5.1.4); a static questionnaire alone doesn't (Position Statement 4.1.1).

The one that surprises people: a client who walks in wanting tox with no provider order behind it can be treated by an RN only if that RN also holds an Electrolysis Practice Act or Cosmetic Art Act license (NCBON cosmetic position statement, Note 1). Yes, really.

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 North Carolina 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:

"Having my own schedule, that flexibility as a mom to say the kids are at school these hours, so I can see patients and make way more than I was making at the hospital."
- Ashley C., RN

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

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 North Carolina? 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. In North Carolina, you can join whether you're just starting out or already running a practice.

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 North Carolina, 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.

North Carolina-specific costs to budget for

Filing articles of organization for the PLLC with the Secretary of State is $125, and the annual report is $200 on paper or $203 online, due April 15 every year after the year you form. Before you file, the Board of Nursing registration for a nursing PLLC is $50, with a $25 renewal due by December 31 each year. If you sell retail product to patients, North Carolina's general sales tax is 4.75% at the state level plus a county rate, so most nurses collect somewhere around 7%, and you'll need a sales and use tax registration with the Department of Revenue first.

So, where do you actually start in North Carolina?

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 North Carolina 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 North Carolina

Do I need a PLLC in North Carolina, or can I use a regular LLC?

A PLLC or professional corporation, and it's a nursing one. North Carolina lists nursing as a professional service (N.C. Gen. Stat. §55B-2(6)) and requires every owner of a professional entity to be a licensee (N.C. Gen. Stat. §55B-4(2)); LPNs can't own one at all. You register with the Board of Nursing through the Nurse Portal for $50, get the Certificate of Registration, then file it with your articles at the Secretary of State. Five Square handles the sequencing.

Can an LPN own or work in an aesthetics practice in North Carolina?

Work, yes. Own, no. The Board of Nursing states plainly that LPNs are not authorized to own professional nursing businesses in full or in part. An LPN performing cosmetic procedures needs an RN, physician, NP, PA, or other licensed practitioner physically on site and supervising (NCBON cosmetic position statement). An RN performing the same procedures doesn't need anyone on site, only a valid order from the provider who evaluated the patient.

Can my medical director do the initial evaluation by telehealth in North Carolina?

Yes. NCMB Position Statement 5.1.4 says a licensee-patient relationship can be established through synchronous or asynchronous telemedicine with no prior in-person visit, as long as the technology is sufficient to diagnose and treat the patient at the standard of care. The limit is on questionnaires: prescribing based solely on a static online form is not acceptable (Position Statement 4.1.1). A live video evaluation with the provider works.

Can a registered nurse own a med spa in North Carolina? Yes, with the right setup. An RN can own the practice outright in North Carolina, through a professional entity.

Do I need a medical director for aesthetics in North Carolina? Yes. North Carolina 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 North Carolina? Yes, within a compliant setup and with the oversight North Carolina 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 North Carolina. 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 North Carolina? Yes. Five Square already supports nurses in North Carolina, so a discovery call is about your timeline and your goals, not whether we're there yet.

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.