The first nurse practitioners (NPs) were educated at the University of Colorado in 1965.  That program prepared Pediatric Nurse Practitioners.  Initially, the NP role was built on the knowledge and skills of the public health nurse and was in direct response to the need for cost-efficient, easily accessible primary or "first contact" health care in rural underserved areas.  Early advances in regulatory reform and statutory recognition for NPs were focused exclusively on access to care issues for rural America, and until recently, differentiation existed in terms of practice privileges based on geographic (rural versus urban) location.  In the 30 years since the first nurse practitioners were educated, a number of nurse practitioner specialties have developed.  They include family practice, pediatrics, women's health, psychiatry, acute care, and community/public health. There are 49,500 nurse practitioners authorized to practice in the United States.  Of these, 3,407 nurse practitioners are currently authorized to practice in Pennsylvania.  Nurse practitioners are one type of Advanced Practice Nurses.  Advance practice nurses (APNs) include nurse anesthetists, clinical nurse specialists, certified nurse midwives, and nurse practitioners.  All APNs require advance education beyond the Bachelor of Science in Nursing (BSN), usually at the Master of Science in Nursing (MSN) level.