There is evidence that nurse practitioners (NP) and physician assistants (PA) are branching into various specialties such as psychiatric, oncology, and pediatrics, but a contemporary understanding of how these specialties are represented in rural settings is missing, especially in light of evolving state scope of practice laws in the U.S. Researchers will use National Provider Identifier registry data to assess trends in specialty and settings and Medicare provider utilization and payment data to explore whether there have been significant changes in the number of clinician types billing for procedures. These findings will inform the Federal Office of Rural Health Policy on areas where the use of NPs and PAs can be enhanced.