Can a nurse open a med spa in Texas?

Key takeaways

A Texas nurse cannot own the medical side of a med spa, because injectables and laser work count as the practice of medicine.

The lawful route is two companies: a physician owns the clinical practice, and you own a management services organization beside it.

Texas gives physician assistants a minority ownership stake inside a physician’s professional entity, and does not extend that route to nurses.

A nurse practitioner still needs a prescriptive authority agreement, and cannot write the standing delegation orders her own staff inject under.

The Texas Medical Board repealed 22 TAC 193.17 in January 2025 and moved cosmetic delegation into rules 169.25 through 169.28.

A nurse can own a Texas med spa business. A nurse cannot own the medicine practiced inside it.

Texas treats botulinum toxin, dermal fillers, and laser treatments as the practice of medicine. That puts the clinical side of the business under a physician-owned entity, whatever your nursing credential. The business side is still yours.

The phrase you will meet everywhere is the corporate practice of medicine doctrine. It is rarely tied to the sections that do the work. This guide names them. It also covers the ownership route Texas gives physician assistants but not nurses, and the delegation rule that breaks a nurse practitioner’s staffing plan.

One housekeeping note before you start. If your protocols still cite 22 TAC §193.17, they cite a rule the Texas Medical Board repealed in January 2025.

Can a nurse own a med spa in Texas?

No nursing license in Texas permits owning the entity that delivers medical treatments. That holds for a licensed vocational nurse, a registered nurse, and an advanced practice registered nurse alike.

Texas has no single statute called the corporate practice of medicine doctrine. It sits across several provisions of the Medical Practice Act, and together they close the door:

• Occupations Code §155.001 — a person may not practice medicine in Texas without a license issued under that subtitle.
• Occupations Code §165.156 — an unlicensed person or corporation commits an offense by holding itself out as entitled to practice medicine.
• Occupations Code §164.052(a)(17) — a physician commits a prohibited practice by aiding or abetting the practice of medicine by an unlicensed party.
• Occupations Code §157.001 — a physician may delegate a medical act to a qualified, properly trained person, and remains responsible for it.

That last section matters more than it looks. Delegation is the only lawful route by which a non-physician puts a needle in a patient’s face in Texas. It runs from the physician outward, and it never transfers ownership of the medicine.

The statutory chain that blocks nurse ownership

The block itself sits in the Business Organizations Code, not the Medical Practice Act. A physician’s practice is a professional entity, either a professional association (PA) or a professional limited liability company (PLLC).

Two provisions decide who may hold a stake in one. Section 301.007(a) says a person may be an owner of a professional entity only if that person is an authorized person. Section 301.003(5) defines the qualifying individual as someone licensed to provide the same professional service the entity provides.

A registered nurse is not licensed to practice medicine. So an RN is not an authorized person for a medical PLLC, and the same reasoning covers an LVN and a nurse practitioner. Section 301.012(a-4) removes any doubt, requiring that an organizer be a physician and that physicians control and manage the entity.

Nurses are not shut out of the practice altogether. Section 301.006(d) says the rule may not be read to stop a professional entity from employing nurses. The clinical entity can pay you a salary. It cannot sell you a share.

Texas does carve out one non-physician ownership route, and nurses are not in it. Under §301.012(a-1), physicians and physician assistants may jointly form and own a PA or PLLC. Subsections (a-2), (a-3), and (a-6) cap it tightly:

• A physician assistant may not be an officer of the entity.
• A physician assistant’s stake must stay a minority, and may never equal any individual physician owner’s stake.
• A physician assistant may not contract with or employ the physician who supervises them.

Advanced practice registered nurses appear nowhere in that provision. Articles that group nurse practitioners and physician assistants together as permitted minority owners are reading a statute that names only one of the two.

Which med spa services count as the practice of medicine

Rule 22 TAC §169.25 names them. Titled Other Delegation, it identifies nonsurgical medical cosmetic procedures as medical acts a physician may delegate and supervise. The rule reaches injecting medication or substances for cosmetic purposes, administering colonic irrigations, and using a prescription medical device for cosmetic purposes.

In practice, that captures most of a profitable treatment menu:

• Botulinum toxin injections, including Botox, Dysport, and Xeomin
• Dermal fillers and injectable skin boosters
• Laser and intense pulsed light (IPL) treatments
• Microneedling that uses prescription serums, and medical-grade chemical peels
• Elective intravenous therapy
• Prescription weight-loss treatments such as semaglutide and tirzepatide

Elective IV therapy picked up an extra layer in 2025. House Bill 3749, known as Jenifer’s Law, took effect on September 1, 2025 and regulates elective intravenous therapy specifically. It leaves the framework for neurotoxins and fillers unchanged.

Facials, manicures, and non-laser skincare sit elsewhere. That side of the menu falls under cosmetology rules administered by the Texas Department of Licensing and Regulation.

Which Texas boards regulate a nurse-owned med spa?

Four of them, and they do not coordinate with each other:

• Texas Medical Board (TMB) — licenses physicians and writes the delegation rules in 22 TAC Chapter 169. It decides whether your medical director is genuinely doing the job.
• Texas Board of Nursing (BON) — holds your license under the Nursing Practice Act at Occupations Code Chapter 301.
• Texas Department of Licensing and Regulation (TDLR) — cosmetology licensing, and certification for laser hair removal.
• Texas Department of State Health Services (DSHS) — registration of laser and radiation-emitting devices.

Satisfying one board does not satisfy another. A physician can lawfully delegate a procedure that your nursing license still does not allow you to perform. Both tests have to pass on the same patient, on the same day.

How a nurse can legally own a Texas med spa through an MSO

You form two companies and connect them with a contract. The structure is standard, and it is what a Texas healthcare attorney will draw for you.

The clinical entity is a PLLC or PA owned by a licensed Texas physician. It employs the treating providers, holds the patient records, and makes every treatment decision. You own the second company, a management services organization, usually called an MSO.

Your MSO owns the business a med spa needs in order to trade. A management services agreement, or MSA, links the two entities and sets out which services the MSO delivers and what it is paid for them.

What the MSO can and cannot do

The dividing line is clinical judgment. Your MSO can hold the lease, the equipment, the brand, and the staff who never touch a patient clinically:

• Premises, fit-out, and equipment leasing
• Marketing, branding, and the website
• Scheduling, reception, and patient communications
• Payroll, human resources, bookkeeping, and IT
• Supplies procurement and inventory

What the MSO must stay out of is narrower and firmer. It cannot:

• Perform or order treatments
• Write or approve clinical protocols
• Decide which patient is a candidate for a procedure
• Direct the physician’s clinical judgment

The patient records belong to the clinical entity, not to your management company.

What makes a management services agreement fail

Regulators read the substance of the arrangement rather than the labels on it. An MSA drafted from a generic template is where most of the risk collects:

• A management fee that sweeps nearly all clinical revenue into the MSO
• A fee tied to the number of patients seen or procedures performed
• Compensation that cannot be defended as fair market value for services genuinely delivered
• Any clause letting the MSO influence treatment recommendations or patient selection
• A physician owner who never sets foot in the building

Percentage-of-revenue fees concentrate the exposure. If the number is not defensible as fair market value, it starts to look like fee-splitting. Federal risk under the Anti-Kickback Statute sits behind that, on top of the state question.

What each nursing license can do in a Texas med spa

Ownership and scope are two separate questions, and the answers diverge by license. This table sets them side by side.

The Texas Board of Nursing publishes no list of approved procedures. It expects you to reason the question through its Scope of Practice Decision-Making Model instead. Two nurses can therefore reach different answers on the same treatment.

Position Statement 15.11 draws the firmest line. RNs without APRN licensure, and LVNs, may not engage in acts of medical diagnosis or prescription of therapeutic or corrective measures. Those acts require independent medical judgment.

Position Statement 15.9 covers lasers. A nurse may deliver nonablative laser therapy under three conditions. She needs documented education in laser safety, a valid order, and medical backup on hand.

The order has to come from a physician, or from an APRN working in collaboration with one. Medical backup matters because treating a bad outcome falls outside nursing scope.

Can a nurse practitioner open a med spa in Texas?

A nurse practitioner can own the business on the same MSO terms as any other nurse, and cannot own the clinical entity. Advanced practice does not change the ownership answer in Texas.

Texas is not a full practice authority state. An NP who prescribes needs a written prescriptive authority agreement (PAA) with a delegating physician under Occupations Code §157.0512. That covers most injectables, weight-loss prescribing, and IV formulations on a med spa menu.

The same statute caps the physician’s side of the arrangement. One physician may hold prescriptive authority agreements with no more than seven advanced practice registered nurses and physician assistants combined, counted as full-time equivalents. That ceiling shapes how many locations a single delegating physician can realistically carry.

Why an NP owner still needs a delegating physician

Because an NP cannot be the source of the delegation her own staff rely on. Position Statement 15.11 says APRNs cannot create standing delegation orders for others to engage in medical aspects of care.

The Board’s own summary is blunter. What a physician delegates to an APRN cannot then be delegated onward by that APRN to someone else.

Read that against a staffing plan and the consequence is concrete. An NP owner who hires two RN injectors cannot write the orders those RNs inject under. A physician has to.

So the medical director is not a signature you buy once during setup. That physician is load-bearing for every RN on your treatment floor, every day you are open.

What your delegating physician must do under Texas rules

Considerably more than sign a contract. The Texas Medical Board rewrote this framework in January 2025. It repealed 22 TAC §193.17 and moved the substance into §§169.25 through 169.28, effective January 9, 2025.

Rule §169.26 sets the general standards. Before a delegated act happens, a physician, physician assistant, or APRN acting under delegation must:

• Establish a practitioner-patient relationship, which is the good faith exam
• Complete and keep an adequate medical record consistent with 22 TAC Chapter 163
• Disclose the identity and title of the individual who will perform the delegated act
• Ensure at least one person trained in basic life support is present while the patient is on site

The same rule settles the on-site question that first-time owners ask most. The physician, PA, or APRN is either on site during the procedure, or immediately available for emergency consultation.

Where the second route applies, the physician must still be able to conduct an emergency appointment with the patient.

Rule §169.27 requires written orders, developed, reviewed, and approved by the delegating physician, describing care for injuries, complications, and emergencies. Rule §169.28 handles disclosure. Your delegating physician’s name and Texas medical license number go in each public area and treatment room, beside the mandatory complaint notice. Staff name tags carry credentials.

Two citations are worth checking before you copy a compliance checklist off the internet. Protocols citing §193.17 point at a repealed rule. The substance carried across, but a stale number tells a reviewer your documents have not been maintained.

The second is Senate Bill 378, which some 2026 articles present as a new Texas law on cosmetic injections. It is not law. The bill passed both chambers and the governor vetoed it on June 2, 2025, so the TMB’s Chapter 169 rules remain the framework.

What it costs a nurse to open a med spa in Texas

Budget for two entities rather than one, and for a physician retainer that recurs every month you trade. The structure carries costs a single-entity business plan will not show.

Published industry estimates for a Texas opening range widely with the treatment menu. A lean, injectables-led build sits far below a device-heavy one, and equipment usually dominates the total. A single quality laser platform can reach six figures on its own.

The line first-time owners underestimate is the medical director retainer. Industry figures for an engaged Texas physician commonly sit in the low thousands of dollars a month. Houston, Dallas, and Austin cost more than secondary markets.

Treat a retainer priced like a software subscription as a warning. Rule §169.26 asks for a physician who is genuinely available, and a fee that cheap usually buys a signature instead.

Three more line items belong in the plan:

• Formation and filing costs for two companies rather than one
• A healthcare attorney to draft the MSA and delegation documents
• Malpractice cover for the entity as well as for yourself

Mistakes that put a Texas nurse’s license at risk

The expensive mistakes are structural, and they tend to surface during a complaint investigation rather than a routine inspection:

• The ghost medical director. A physician who signs protocols and never appears fails §169.26, and exposes that physician under §164.052(a)(17).
• Injecting before the orders exist. With no written order under §169.27 there is no lawful delegation, whatever your training certificate says.
• Protocols covering part of the menu. Orders written for neurotoxins do not authorize GLP-1 prescribing, microneedling, or IV therapy.
• A management fee that sweeps clinical revenue. This is the clause that turns a legitimate MSO into an alleged fee-splitting arrangement.
• Treating ownership as permission. Owning the MSO widens your business rights and leaves your clinical scope exactly where it was.
• Skipping the good faith exam. A returning patient, a package, or a gifted treatment each still needs its own exam and documented consent.

Your nursing license is the asset most exposed here. The Board of Nursing can act on your practice under Position Statement 15.14. It puts your duty to promote a safe patient environment above an employer’s policy or a physician’s order.

How Pabau supports a compliant nurse-owned med spa in Texas

A two-entity structure doubles the paperwork one front desk has to keep straight. The clinical record belongs to the physician’s entity, while your marketing, scheduling, and payments run through the MSO. Both sides have to be defensible if the Texas Medical Board asks a question.

Practice management software like Pabau keeps the clinical half in one place. These all attach to the same client record:

• Consent forms and the good faith exam note
• The treating provider recorded on each appointment
• The batch and lot number of what was injected
• Before-and-after photos

That is what rules §169.26 and §169.28 ask you to evidence. When a record must show who performed a procedure and under whose order, the answer sits on the appointment itself. Pabau Scribe, our AI scribe, drafts the treatment note so your provider finishes charting in the room.

Patients complete forms and consents through the online booking portal before they arrive, so your team does not rekey them by hand. Your front desk stops chasing signatures between clients, and you get to finish the day on time.

Keep Texas delegation records audit-ready

Pabau ties consent forms, good faith exam notes, treating-provider details, and injection batch numbers to one client record. Your delegation paperwork stands up without a second filing system.

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Conclusion

The honest read on Texas is that the structure is the work. Draw the physician-owned entity and your MSO properly, then match the delegation paperwork to the treatment menu. After that, a nurse-owned med spa trades like any other business you own.

What that structure buys is narrower than it first appears. It buys you the business, the brand, and the profit from running it well. It does not widen your license, and it does not make your delegating physician optional.

Pay a Texas healthcare attorney to draft the MSA and the delegation documents together. That fee is small beside a complaint investigation reaching your nursing license, and it is the one cost here worth paying twice.

Book a demo to see how Pabau keeps consent, charting, and treating-provider records straight across a physician-owned practice and your management company.

Continue your research

Opening in California instead? Can a nurse open a med spa in California compares the ownership caps and the professional corporation rules that apply there.

Need to find and vet the physician? Medical director for a med spa in Texas covers what the role involves, what it costs, and how to structure the agreement.

Working through the permits next? Texas med spa licensing laws lays out the licenses, registrations, and board requirements in order.

Want the launch steps in sequence? How to open a med spa as a nurse walks the ten steps from credential check through to opening day.

Checking who else can hold a stake? Who can legally own a med spa in Texas breaks down physician ownership, MSOs, and the entity types Texas allows.

Frequently asked questions