A Nurse Practitioner Is Opening a DPC Practice in Rhode Island. The Model Is Spreading Beyond Physicians.

This summer, a nurse practitioner named Kyle Wardle will open First Track Primary Care in Wakefield, Rhode Island. Pre-enrollment has begun. The model: flat monthly memberships, no insurance billing, an intentionally limited patient roster, and extended visits with a single dedicated provider.

That’s Direct Primary Care. And Wardle isn’t a physician.

The Scope of Practice Shift That Made This Possible

Direct Primary Care has, since its earliest days, been a physician-led model. The pioneers who built it — Josh Umbehr in Kansas, Garrison Bliss in Washington, the doctors who coined the term — were all MDs and DOs. The movement’s advocacy organizations, conferences, and legal frameworks have been built around physician ownership.

That’s no longer the only version of the story.

As of 2026, 28 states and Washington, D.C. grant nurse practitioners full practice authority — meaning they can practice, diagnose, and treat patients without physician supervision or a collaborative practice agreement. In those states, nothing legally prevents an NP from doing what Kyle Wardle is doing: hanging out a shingle, enrolling members, and running a primary care practice entirely outside the insurance billing system.

The problem that DPC solves isn’t physician-specific. It’s structural. Traditional primary care, whether delivered by a physician or an NP, runs on the same broken engine: panels too large to give patients time, administrative overhead that consumes billable hours, and fee-for-service payments that reward volume over relationship. When nurse practitioners working in employed settings describe the same frustrations physicians describe — rushed 10-minute visits, four patients an hour, inbox that never empties — they’re identifying the same problem. The DPC membership model is one answer to that problem, regardless of which credential hangs on the wall.

What NP-Led Direct Care Looks Like

First Track Primary Care describes its model in language that any DPC physician would recognize: “direct access to the provider,” “extended visit times,” “personalized, individualized care,” and “intentionally limited membership to maintain quality relationships.” Wardle cited the same experience gap that pushes physicians toward DPC — “longer wait times, shorter visits, and an increasing disconnect” between providers and patients — as his reason for leaving traditional healthcare.

He’s not alone. Nurse practitioners with independent practice authority in states like New Hampshire, North Dakota, and New Mexico are opening direct care offices that bypass health insurance entirely, operating on monthly membership fees in the $45-$100 range and offering the same primary care services — annual exams, chronic disease management, same-day sick visits — that physician DPC practices provide.

Family nurse practitioner Alina Love-Moore, who runs Love Wellness Ltd., a membership-based direct care practice, frames it simply: “Direct primary care takes insurance out of the equation for routine care, which means patients get more access, more time, and more transparency.” That framing is identical to how physician DPC advocates have explained the model for fifteen years.

What This Means for Physician DPC

The short answer: probably not much — in the near term, in most markets.

NP-led direct care practices tend to attract patients who weren’t in any physician DPC practice to begin with. The United States is projected to face a shortage of up to 55,200 primary care physicians by 2032. In that environment, an NP opening a membership practice isn’t pulling patients away from an established DPC physician. They’re pulling patients away from a waiting list or an urgent care clinic.

The longer-term question is about model identity. “Direct Primary Care” has a specific meaning in law and policy — several states have enacted DPC practice acts that define who can operate under that term and under what conditions. Most of those statutes were written with physician ownership in mind. As NPs adopt the model in states with full practice authority, the legal and definitional lines will get more complicated. That’s not a crisis, but it is worth tracking. DPC Frontier maintains the most current state-by-state regulatory picture.

There’s also something worth observing about what the NP-DPC pattern reveals. When independent nurse practitioners, given the chance to practice any way they want, choose the DPC membership model — it’s a signal that the model’s core logic is strong enough to survive outside its original context. That’s not dilution. That’s proof of concept.

What This Means

If you’re a physician considering DPC, NP-led direct care practices aren’t a competitive reason to hesitate. They’re the same argument you’ve already been making about DPC — framed by someone who came to the same conclusion from a different starting point.

If you’re already running a DPC practice in a state with full NP practice authority, you might start seeing NP-owned membership practices open nearby. The competitive question is less about direct overlap and more about public education: when a patient considers both options, do they understand what credentials mean? That’s a patient communication issue, not a market threat.

For the DPC movement broadly, the model’s expansion into NP practice is a proxy measure for how well the concept has been articulated. It’s one thing when healthcare journalists write about DPC. It’s a different signal when clinicians — without being part of the DPC community, without attending DPC Summit, without reading the advocacy literature — arrive at the same model independently because it solves the same problem.

First Track Primary Care opens this summer in Wakefield, Rhode Island. Kyle Wardle is enrolling members now. The model, it turns out, doesn’t require a specific credential to recognize what’s wrong or to know how to fix it.