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In Wyoming, Botox injections are considered medical practice and must be administered by doctors, private practice nurse practitioners (NPs) if the treatment falls within their field of practice, or physician assistants (PAs), both under the guidance and delegation of a physician. Under the supervision of a physician or a nurse practitioner, registered nurses (RNs) may inject Botox if they have the expertise and skill to perform the procedure competently and safely, which must include at a minimum:[1] clinical training with an experienced provider; [2] neuromodulator training; and [3] qualification course completion Physicians may also assign this practice to unlicensed staff under direct supervision, which means that the physician must be physically present in the room and ready to interfere at any time.