Nurse practitioners are the fastest-growing segment of the healthcare workforce in America. With over 461,000 NPs now practicing in the United States -- a 7% year-over-year increase -- and U.S. News naming nurse practitioner the #1 job in America for 2025, the profession is at an inflection point. Thirty-four states plus the District of Columbia now grant full practice authority (FPA), allowing NPs to evaluate, diagnose, prescribe, and manage patient care without physician oversight. At the current rate of legislative adoption, all 50 states may reach FPA by 2028-2030.
Yet despite this massive shift, no telehealth platform is purpose-built for prescribing nurse practitioners. Every option on the market was designed for a different practitioner type: therapists, nutritionists, or physician-led practices. If you are an NP entrepreneur launching an independent practice, a health tech founder targeting this underserved market, or an investor evaluating telehealth opportunities, this guide breaks down the market opportunity, the competitive gaps, the features that matter, and what it takes to build nurse practitioner telehealth software that actually fits.
The NP Market Opportunity: By the Numbers
The nurse practitioner market is not just growing -- it is accelerating. The Bureau of Labor Statistics projects 46% employment growth for NPs from 2023 to 2033, making it the fastest-growing occupation in the country. That trajectory is driven by three compounding forces: a persistent primary care physician shortage, expanding scope-of-practice legislation, and rising patient demand for accessible, affordable care.
Full Practice Authority Is Reshaping the Landscape
Full practice authority is the single biggest catalyst. When a state adopts FPA, it removes the requirement for physician collaboration or supervision, enabling NPs to open independent practices. In 2024, 29 states had FPA. By early 2026, that number has climbed to 34 states plus DC. Research consistently shows that NP entrepreneurship surges after FPA adoption -- one study documented a 374% increase in self-employed NPs in states that transitioned to full practice authority.
The financial incentive is real. NPs in FPA states earn 12-15% more than their counterparts in restricted-practice states. Independence means keeping the full margin on patient visits rather than paying overhead to a supervising physician or employing practice.
The Addressable Market Is Small but Growing Fast
Today, only 1.2-3.9% of NPs are self-employed -- roughly 18,000 practitioners. That number looks modest until you factor in the pipeline: an estimated 15,000 additional NPs are in various stages of transitioning to independent practice, drawn by new FPA legislation and the economics of autonomy. As more states adopt FPA and awareness grows, the self-employed NP population could triple within five years.
For a telehealth platform targeting this segment, even modest penetration of 280-500 practices represents a viable path to $1M+ in annual recurring revenue. The market is small enough that a focused product can dominate, but growing fast enough that the ceiling keeps rising.
Why Existing Platforms Fail Nurse Practitioners
The NP practice management software landscape is littered with tools that were built for someone else. Every major platform in the space was designed around a different clinical workflow, and NPs -- particularly prescribing NPs -- are forced to cobble together fragmented systems that do not communicate. Tool fragmentation is the number one pain point we hear from NP practice owners.
SimplePractice: Built for Therapists
SimplePractice dominates the mental health and counseling market, but its roots show. E-prescribing is available only through a third-party integration with DrFirst, and users report that activation takes 8+ weeks and the prescribing experience is unreliable. The platform was not designed for medical prescribing workflows -- it was designed for therapy notes, treatment plans, and session scheduling. NPs working in family practice, urgent care, or psychiatric prescribing hit limitations quickly.
Healthie: Built for Nutritionists
Healthie has raised over $40 million and built a strong platform for dietitians and wellness practitioners. E-prescribing is available through DoseSpot, but it is implemented as an iFrame embed -- essentially a separate application running inside a window. It costs an additional $40 per month per provider, and the experience is disconnected from the rest of the charting workflow. More critically, NP-specific features like scope-of-practice tracking, collaborative agreement management, and DEA validation simply do not exist.
Jane App: No E-Prescribing at All
Jane App has earned a loyal following among allied health clinics -- chiropractors, physiotherapists, massage therapists. The scheduling and charting experience is polished. But there is no e-prescribing capability whatsoever, which makes it a non-starter for any NP who prescribes medications as part of their practice.
PracticeQ, TherapyNotes, ICANotes
Each of these platforms targets a specific practitioner type (general allied health, therapists, and behavioral health respectively) and none are optimized for the prescribing NP workflow. They solve pieces of the puzzle but leave significant gaps around medication management, controlled substance prescribing, and multi-state compliance.
Kareo/Tebra: Built for Physician Practices
Kareo (now Tebra) is a general practice management and EHR platform designed primarily for physician-led practices. It offers robust billing and e-prescribing, but the complexity and cost reflect its target market. Solo NPs and small NP-led practices find it expensive, over-engineered for their needs, and designed around workflows that assume physician oversight rather than independent NP practice.
The Core Problem: Tool Fragmentation
The result is that most independent NPs end up stitching together four to five separate systems: one for EHR and charting, one for appointment scheduling, one for telehealth video visits, one for e-prescribing, and one for billing. These systems do not share data. Patient information gets entered multiple times. Prescribing requires switching contexts mid-visit. Billing requires manual reconciliation across platforms.
This is not a minor inconvenience -- it is a structural inefficiency that costs NPs hours per week and creates real compliance risk. A platform purpose-built for prescribing NPs would consolidate these workflows into a single system, and that consolidation is the core value proposition.
Essential Features for an NP Telehealth Platform
Building nurse practitioner practice software requires understanding the specific clinical, regulatory, and business workflows that NPs navigate daily. The following features represent the minimum viable product for a platform that can genuinely replace the patchwork of tools NPs currently use.
Seamless Booking-to-Video-to-Prescribe-to-Bill Workflow
The single most important architectural decision is treating the entire patient encounter as one continuous workflow. When a patient books an appointment, that booking should flow directly into a telehealth video session. During the video visit, the NP should be able to prescribe medications without leaving the encounter screen. After the visit ends, the billing code should auto-populate based on the visit type and documentation.
Four separate tools become one. That is the product differentiation.
Native E-Prescribing (Not an iFrame)
This is the technical detail that separates a real NP platform from a glorified video chat tool. Native e-prescribing means the prescribing workflow is built directly into the application through full API integration with an e-prescribing middleware provider. The NP searches for medications, reviews drug interactions, confirms dosage, and sends the prescription to the pharmacy -- all without leaving the telehealth encounter interface.
Compare this to iFrame-based implementations where a third-party prescribing window opens inside the application. The iFrame approach creates context-switching, limits data sharing between the prescribing module and the patient chart, and often introduces latency and visual inconsistency. For a platform positioning itself as purpose-built for NPs, native prescribing is table stakes.
For more on the technical implementation of e-prescribing systems, see our E-Prescribing Integration Guide.
NP-Specific Charting Templates
Nurse practitioners work across multiple specialties, and each requires different documentation patterns. A family practice NP needs templates for well visits, chronic disease management, and acute care. A psychiatric mental health NP (PMHNP) needs templates for psychiatric evaluations, medication management follow-ups, and PHQ-9/GAD-7 screening integrations. An urgent care NP needs rapid templates for common presentations. A med spa NP needs cosmetic consultation and treatment documentation.
Pre-built templates for each NP specialty reduce documentation time by 30-50% compared to starting from blank notes, and they ensure that documentation meets the specific coding and compliance requirements for each visit type.
State-by-State Scope-of-Practice Engine
This is where NP-specific software diverges sharply from general practice management tools. Scope-of-practice laws vary by state, and those laws directly affect what an NP can prescribe, whether a collaborative physician agreement is required, and what documentation must be maintained.
A purpose-built NP platform should include a scope-of-practice engine that:
- Tracks the NP's active state licenses and their expiration dates
- Enforces prescribing restrictions based on the patient's state (not just the NP's home state)
- Flags when a collaborative physician agreement is required and tracks agreement status
- Updates automatically as state laws change
This feature alone justifies switching from a generic platform. No existing tool offers it.
DEA Prescribing Validation and EPCS
Nurse practitioners with DEA registrations can prescribe controlled substances, but electronic prescribing of controlled substances (EPCS) requires specific technical compliance. The platform must support identity proofing, two-factor authentication for each controlled substance prescription, and audit trail generation that meets DEA requirements under 21 CFR Part 1311.
EPCS compliance is not optional -- it is a federal requirement for any platform facilitating electronic controlled substance prescriptions.
Multi-State Telehealth Compliance
NPs practicing telehealth across state lines face a complex web of licensing requirements. The platform needs to track which states each NP is licensed in, verify that the patient is located in a state where the NP holds an active license at the time of the visit, and document the patient's location as part of the encounter record.
Some states participate in the APRN Compact, which simplifies multi-state practice. A well-designed compliance engine should account for compact membership alongside individual state licenses.
Patient Intake with Insurance Verification
Before a patient even sees the NP, the platform should handle intake forms, consent documentation, and real-time insurance eligibility verification. Eligibility checks before appointments prevent the common problem of providing care and then discovering the patient's insurance is inactive or the service is not covered.
Superbill Generation for Out-of-Network Billing
Many independent NPs, particularly in the early stages of practice, operate out-of-network. Their patients pay at the time of service and then submit superbills to insurance for reimbursement. The platform should auto-generate superbills with accurate CPT codes, ICD-10 diagnoses, NPI numbers, and the NP's tax ID -- ready for the patient to submit.
Technical Architecture Decisions
Building a telehealth platform for nurse practitioners involves several critical technology choices that affect cost, timeline, and scalability. Here are the decisions that matter most.
E-Prescribing Middleware
The e-prescribing layer is the most consequential technical decision. Two realistic options exist for startups:
Weno Exchange is the most accessible starting point. It offers self-serve onboarding, lower costs, and sufficient functionality for an MVP. Per-prescriber costs run approximately $15-30 per month. The trade-off is a less polished API and fewer customization options for the user experience.
DoseSpot Full API is the upgrade path for a production-grade platform. DoseSpot offers a comprehensive API (not just the iFrame embed that platforms like Healthie use) that enables true native prescribing integration. Per-prescriber costs range from $40-75 per month. The onboarding process is more involved, but the result is a seamless prescribing experience that feels built-in rather than bolted-on.
The recommended approach: launch your MVP with Weno Exchange to validate the market and onboard early customers, then invest in DoseSpot Full API integration once you have revenue and user feedback to guide the implementation.
HIPAA-Compliant Video
Telehealth video must be HIPAA compliant, which means the video provider must sign a Business Associate Agreement and support end-to-end encryption. Twilio Video and Vonage (now part of Ericsson) both offer HIPAA-eligible video APIs with signed BAAs. Both support adaptive bitrate streaming, screen sharing, and recording (with appropriate consent workflows).
Budget $0.004-0.01 per participant per minute for video infrastructure costs.
Backend Architecture
For a healthcare SaaS platform, reliability and compliance trump novelty. Node.js with TypeScript or Ruby on Rails with PostgreSQL are both battle-tested choices. PostgreSQL is strongly recommended for the database layer due to its robust support for complex queries, JSON fields (useful for flexible charting templates), and row-level security policies that support HIPAA access controls.
Authentication and Access Control
HIPAA requires unique user identification, automatic session timeouts, and audit controls. Implement SSO with mandatory multi-factor authentication for all clinical users. Role-based access control (RBAC) should distinguish between NP providers, administrative staff, and billing personnel, with each role seeing only the data necessary for their function.
For a deeper dive into HIPAA technical requirements, see our complete HIPAA compliance guide.
Per-Prescriber COGS
A critical business consideration: e-prescribing middleware costs $15-75 per month per prescriber. This is a direct cost of goods sold that affects your SaaS pricing model. If your platform supports 200 prescribers at an average of $45/month in middleware costs, that is $9,000/month in COGS before hosting, video, or any other infrastructure. Price accordingly.
Pricing Model for NP Software
Pricing a nurse practitioner practice management platform requires balancing the value delivered against competitive alternatives and per-prescriber COGS.
Target Annual Contract Value
The sweet spot for an all-in-one NP telehealth platform is $299-499 per month per practice. This price point is justified by the consolidation value -- replacing four to five separate subscriptions that collectively cost $200-400 per month when you add up scheduling ($30-50), telehealth video ($50-100), e-prescribing ($40-75), EHR ($50-100), and billing ($30-50).
At $299 per month, a single practice saves money while getting a better, more integrated experience. At $499 per month, practices with multiple providers or higher patient volumes get additional capacity and features.
Path to $1M ARR
The math is straightforward:
- At $299/month: ~280 practices = $1M ARR
- At $499/month: ~170 practices = $1M ARR
Given an addressable market of 18,000+ self-employed NPs (and growing), capturing 170-280 practices represents less than 2% market penetration. That is achievable with focused go-to-market execution targeting NP professional associations, state NP organizations, and NP-focused continuing education channels.
Competitive Context
SimplePractice charges $29-99 per month but is missing core NP features. Healthie charges $19-149 per month plus $40 per month for e-prescribing add-ons. Neither offers the NP-specific compliance features described above. The higher price point of $299-499 is defensible because it replaces multiple tools and adds capabilities that no competitor offers.
Build Sequence for MVP
Building a telehealth platform for nurse practitioners does not require a two-year development cycle. A phased approach gets a viable product to market in approximately eight months, with paying customers possible as early as month three.
Phase 1: Core Encounter Workflow (3 Months)
The first phase delivers the minimum product that an NP can use to see patients:
- Patient scheduling and booking with automated reminders
- HIPAA-compliant telehealth video with waiting room functionality
- Weno Exchange e-prescribing integration for medication prescribing during visits
- Basic encounter documentation with customizable note templates
- Patient portal for intake forms, appointment management, and secure messaging
At the end of Phase 1, you have a functional telehealth platform that an NP can use to book visits, see patients via video, and prescribe medications. This is enough to onboard beta customers and begin generating revenue.
For detailed cost estimates on building a telemedicine platform, see our telemedicine development cost breakdown.
Phase 2: NP-Specific Clinical Features (2 Months)
Phase 2 adds the features that differentiate an NP platform from a generic telehealth tool:
- Specialty-specific charting templates for family practice, psychiatric, urgent care, and med spa NPs
- DoseSpot Full API integration replacing the Weno MVP implementation for a native prescribing experience
- Drug interaction checking and formulary integration
- Lab order integration for common reference labs
Phase 3: Compliance and Revenue Features (3 Months)
Phase 3 builds the compliance and billing infrastructure that enables NPs to scale their practices:
- State-by-state scope-of-practice engine with automated compliance checking
- Collaborative physician agreement tracking and documentation
- Multi-state license management with expiration alerts
- DEA registration validation and EPCS compliance
- Insurance eligibility verification and claims submission
- Superbill generation for out-of-network billing
- Revenue cycle dashboard with key financial metrics
Ongoing: Integration and Expansion
After the initial three phases, the product roadmap shifts to integrations and market expansion:
- EHR integration with major systems via FHIR APIs for NPs who work in hybrid settings
- APRN Compact compliance automation
- AI-assisted documentation and coding suggestions
- Referral network features connecting NPs with specialists
Frequently Asked Questions
What software do nurse practitioners use for telehealth?
Most nurse practitioners currently use a combination of general-purpose tools: an EHR system like Athenahealth or SimplePractice for charting, a separate telehealth video platform like Doxy.me or Zoom for Healthcare for virtual visits, a third-party e-prescribing tool like DrFirst or DoseSpot for medications, and a separate billing system for claims. This fragmented approach creates inefficiency, data silos, and compliance gaps. The market opportunity exists precisely because no single platform addresses the complete prescribing NP workflow -- booking, video visits, native e-prescribing, NP-specific charting, scope-of-practice compliance, and billing -- in one integrated system.
Do NPs need e-prescribing software?
Yes. Nurse practitioners with prescriptive authority (which includes all NPs in full practice authority states) must use e-prescribing for most medications. As of 2024, Medicare requires electronic prescribing for Part D medications, and most state Medicaid programs have similar mandates. For controlled substances, electronic prescribing (EPCS) is now required in over 40 states. Beyond regulatory requirements, e-prescribing reduces medication errors, improves pharmacy workflow, and enables drug interaction checking. For any NP telehealth platform, e-prescribing is not a nice-to-have -- it is a core requirement.
How much does it cost to build an NP practice management platform?
A purpose-built NP telehealth platform typically costs $250,000-$500,000 for initial development across the three phases described above: core encounter workflow ($80-150K), NP-specific clinical features ($60-120K), and compliance and billing features ($100-200K). Ongoing costs include e-prescribing middleware ($15-75 per prescriber per month), video infrastructure ($0.004-0.01 per participant per minute), hosting ($2,000-5,000 per month), and maintenance and iteration ($10,000-20,000 per month). The total first-year investment, including development and infrastructure, typically falls in the $350,000-650,000 range. This investment is recoverable within 12-18 months at the pricing model described above with 100+ practices.
The Window Is Open
The convergence of NP workforce growth, expanding full practice authority legislation, and the absence of purpose-built NP telehealth software creates a clear market opportunity. The practitioners are there. The regulatory tailwinds are accelerating. The competitive landscape is a patchwork of tools designed for someone else.
The question is not whether a purpose-built NP telehealth platform will succeed -- it is who will build it first and capture the loyalty of a fast-growing, underserved market.
Building a telehealth platform for nurse practitioners? Of Ash and Fire specializes in HIPAA-compliant healthcare software with deep e-prescribing and EHR integration experience. Schedule a free consultation to discuss your NP platform requirements.