Abstract
Nurse practitioners (NPs) are increasingly stepping into ownership roles to address critical gaps in primary care, particularly in underserved communities. This feature highlights four NP-led practices across the United States, exploring how autonomy, clinical excellence, and community engagement converge in these grassroots models. Drawing on first-person narratives, the article examines the motivations, challenges, and innovations of NP entrepreneurs who are reshaping access and outcomes. Their stories reflect a broader shift toward provider diversity and patient-centered care—and underscore the need for policies that support NP ownership through full practice authority, business training, and equitable reimbursement.
Keywords: Nurse practitioners, primary care, primary care access, primary care practice, nurse practitioner entrepreneur
Innovation has been at the heart of the nurse practitioner (NP) profession since Dr. Loretta Ford cofounded the role in 1965 to address gaps in rural access. In the decades since, both the role and the demand for it have grown, driven by a persistent need for access to care in underserved communities and a rapidly aging population.
Today, NPs are indispensable to the primary care workforce. In some areas, one in every two or three providers is a NP. Their holistic, relationship-centered approach has earned the highest satisfaction scores from patients and helped bend the cost curve in health care by emphasizing prevention over intervention.
Less studied but equally impactful is the rise of NP-owned clinics, often found in areas facing severe provider shortages. Faced with limited options and recognizing that help is not on the way, NPs are stepping up to fill the gaps, launching small, high-impact practices rooted in the culture and needs of their communities.
This is not a side note in health care—it is a shift. Practice ownership brings a level of autonomy and responsiveness that is hard to achieve within traditional systems. From mobile visits and behavioral health integration to community-based outreach and culturally competent care, NPs are pioneering a new model of primary care.
Since 2000, the number of states with full practice authority has grown from 10 to 27, plus Washington, D.C. And even in restricted states, as these profiles illustrate, NPs are navigating complex regulatory landscapes to answer the call.
We are proud to spotlight four stories among thousands: Tamara, John, Lindsey, and Naga. Their paths are unique, but they share a common purpose and exemplify a quiet revolution in how primary care is being delivered to millions without fanfare.
Tamara Washington, DNP, APRN, FNP-C
Elite NP Clinic/DeSoto, Texas
Tamara Washington always knew she would open her own clinic, one that brought back the personalized care that she saw disappearing from corporatized practice.
After working in other settings, she launched Elite NP Clinic in 2017 in her hometown of DeSoto, Texas, undeterred by the hurdles of collaboration costs and a lack of mentorship. From the start, Tamara made it clear, “this was a different model.” Even the name—“Elite NP”—was chosen to telegraph her identity and alternative approach.
More than 400 glowing reviews speak to her impact, starting with the patients who followed her from her previous clinic. Her “clients,” as she calls them, are given a hospitality feel, between unhurried visits, same-day access, and a calming environment that her and her team have built.
With more than 1,200 patients now, Tamara serves her local community, primarily African American adults, including those with complex chronic conditions. Her approach combines education, advocacy, and active listening. She recalls catching a missed diagnosis in a younger patient: “I had a client who was suffering from multiple joint pains and swelling out of the blue. I just followed the guidelines, and we got back a positive test for lupus. Now she has a treatment plan, she's managing the disease, and she's had kids since. She was so grateful.”
Building up her practice was hard earned. Although her physician peers were quick to seek referrals as her panel grew, they were slower to reciprocate. Tamara grew through grassroots outreach: attending health fairs, sending mailers, and creating a network on her own. Despite the challenges, she has upbeat about the future, as she sees more patients specifically seeking out an NP model and more NPs looking to open practices.
Today, she mentors other NP entrepreneurs, helping them navigate the same business questions she once faced, now with a supportive shoulder. By her estimate, there are more than 1,000 NP practices across Texas, driving changes on the ground that she hopes will finally turn the tide on full practice authority and let NPs deliver for their communities.
John Mandeville, FNP-BC
Granite State Family Health/Amherst, New Hampshire
www.granitestatefamilyhealth.com
John Mandeville's path to owning a clinic began not in medicine, but in the military. Raised in a working-class family in Salem, Massachusetts, his early hopes to attend the Naval Academy were sidelined by a football injury. After his military service, he spent years climbing the corporate ladder, eventually deciding he wanted something more meaningful.
It was his mother who planted the seed much earlier. Sitting at the kitchen table, she suggested that he apply to nursing school. At the time, even $384 a month for tuition seemed impossible. But years later, John made the leap after witnessing the way NPs cared for their patients while working as an emergency medical technician.
After becoming an NP and relocating to rural New Hampshire, he opened Granite State Family Health, leaving behind a high-volume role at a corporate clinic where extra time with patients was outside the bounds. He left that job with a big vision but a limited plan.
His military background shaped his leadership and built connections with overlooked populations. “There's something about sitting down with someone who's worn the uniform or knows what it's like to be the odd one out,” he says. That shared experience helped him build trust with veterans, blue-collar workers, and patients navigating mental health challenges.
John is known for never rushing and always reviewing full patient histories. “I've had people say, ‘You're the first person who's actually looked at my chart.’”
After just 6 months, his solo venture quickly expanded to a full-service clinic with integrated behavioral health, powered almost entirely by word of mouth and his commitment to meaningful care.
He remains passionate about creating access for working families and sees his clinic as a blueprint for small-town practices led by NPs.
Lindsey Maloney, DNP, APRN, FNP-C
Nutmeg Primary Care/Kent, Connecticut
During the COVID-19 pandemic, as many clinics closed their doors, Lindsey Maloney opened hers, but on wheels. With access already limited in rural Connecticut, she launched a mobile practice to serve homebound patients, propelled by her background in complex care.
As the pandemic eased, families began asking her to open a permanent location. The nearest alternatives were miles away and notorious for long lines and rotating providers. Nutmeg Primary Care was born out of that need for something local and personal.
Lindsey embedded herself in her small town, offering free physicals at fire stations, speaking at senior centers, and hosting holiday events. “We did a Trunk or Treat [Halloween event] to launch and people came from across the state. They brought food and drink. I felt like I'm now here in the community. This is exactly what I wanted.”
Within 3 months of opening her brick-and-mortar clinic, and with her mother running the front desk, she had a waitlist. But Lindsey admits those early days were nerve-wracking. “I had overhead, additional staff … I didn't know how many people were going to walk through the door.”
She did not have a formal business background and said if she could go back, she would have wanted at least one course on basics like contracts, budgeting, and organizational systems. “We don't learn this stuff in school … Billing is never taught and it's such a big part of our jobs. When it's your company, who's fixing the billing? No one.”
She credits her success to listening carefully to the community, going the extra mile for her patients, and surrounding herself with a mission-aligned team. “My staff … will literally cross the earth for this practice. They will do anything for our patients.”
Lindsey also mentors aspiring NP owners, helping them prepare for the realities of ownership. “You start at the top, with a goal or a milestone, and work backwards. Fires are going to come your way … but they're not going to derail you if you've got a plan.”
Between widening provider shortages, longer life expectancies and a shift to value-based care, she believes that NPs are poised to lead the future of primary care. “This is exactly where NPs fit in … there's no way it's not going to be us. It is going to be us.”
Nagavalli Thiruvallavan, DNP, MSN, NP-C, C RRN
Adult & Geriatric Primary Care/Metuchen, New Jersey
Long before opening her own clinic, Nagavalli Thiruvallavan—Naga to her patients—spent nearly a decade as a nurse in India. Trained in a Catholic hospital system with an emphasis on holistic health and frequent departmental rotations, she developed a foundation in patient-centered care that would eventually carry forward into her practice.
After immigrating to the United States in 1995, she followed a familiar path for internationally trained nurses: starting over. She became an NP in 2012 and worked in high-volume outpatient and inpatient roles, often seeing 25 or more patients a day. “You're constantly seeing and making decisions,” she said. “But there's not a lot of time to know the patient or educate them.”
That experience left her wanting more. “When you know the patient well, it does take time, but you're able to base your plan of care on what they actually need—not just the acute problem,” she explained. “You can help them prevent complications, make small changes and really support them long-term.”
She waited until her children were grown and finances were stable before opening AG Primary Care. In the meantime, she worked as a 1099 contractor, picking up key skills in credentialing, billing, and practice management. “They don't teach you this in NP school,” she said. “I was learning on my own. You figure it out by doing it.”
Today, her practice serves a diverse, multiethnic population in central New Jersey, including African American, Hispanic, Asian, and immigrant families who struggle to find consistent, culturally competent care. “Every patient comes to me, they are unique,” she said. “Their beliefs are different; their backgrounds are different. I must individualize the care.”
Her clinic blends functional medicine, evidence-based obesity care, and traditional primary care, always with education at the core. “I want the community to see what an NP can do,” she said. “And I want people to see the value we bring.”
Conclusion
Across different geographies and patient populations, these four NP-owned clinics share powerful common threads: deep community roots, strong patient trust, and a relentless commitment to personalized care.
Each founder navigated significant barriers, restrictive laws, steep collaboration costs, limited business training, and still succeeded in creating access where it was most needed. What began as a personal mission has evolved into a professional model for what modern primary care can be.
Their stories align with national data: in states with full practice authority, NPs deliver care that matches physician quality, with higher patient satisfaction and fewer avoidable hospital visits.
The success of NP-owned clinics makes a compelling case for expanding full practice authority, not just for NPs, but for the communities they serve. In many areas, they are the only providers for miles. And for the NPs themselves, ownership has brought renewed purpose, allowing them to innovate and advocate in ways the health care system rarely allows.
To meet rising demand and address persistent care deserts, NP-led practices must be a national priority. That means advancing full practice authority in all 50 states, modernizing reimbursement models, and investing in infrastructure that supports NP entrepreneurship.
As these stories show, NPs are not waiting for permission. They are already leading.
Acknowledgments
Acknowledgments: The authors thank Duet Technologies, Inc. for their support in completing interviews. J. Goldberg, W. Wright, and A. Ortiz are affiliated with and have financial interest in Duet Technologies, Inc., an organization dedicated to supporting independent Nurse Practitioner-led practices. Duet Technologies provided funding for support in writing this manuscript.
Authors' contributions: J. Goldberg contributed to conceptualization, interview process, drafting and editing; N. Dholakia contributed to drafting and editing; W. Wright contributed to the conceptualization, validation, and editing; A. Ortiz contributed to the interview process and editing.
Footnotes
Competing interests: The authors report no conflicts of interest.
Contributor Information
Jonathan Goldberg, Email: jonathan@joinduet.com.
Nisha Dholakia, Email: nisha.dholakia@gmail.com.
Wendy Wright, Email: Wendy@joinduet.com.