Does a med spa have to register or hold a license in Nebraska?

Short answer
Not directly — the cited rules create no "med spa" credential, but premises offering esthetics must be licensed as a salon in their own right ($150 to open, $150 biennial), separately from each esthetician's own license ($95, then $118).

Nebraska licenses BOTH the practitioner and the premises. No person may operate a cosmetology establishment unless it is licensed by the department, and no person may practice cosmetology anywhere other than a licensed establishment except as the act specifically permits; a salon license carries its own physical requirements, beginning with a fixed, permanent structure separated from other business or residential activity. Esthetics itself is the practice for compensation of using an electrical or mechanical apparatus or applying cosmetic preparations upon the skin for personal beauty care, and an esthetician is a person licensed to perform all of the practices of esthetics. None of these provisions creates a MED-SPA registration as such — the premises license they require is the cosmetology one. The price is set by rule rather than by statute: an esthetics salon pays $150 to open and $150 on each biennial renewal, and the esthetician working in it pays $95 and then $118. On compounded drugs the Pharmacy Practice Act draws both lines in one section: a person authorized to compound may do so on a practitioner’s order, for research or teaching, or for office use only and not for resale, in compliance with USP chapters 795 and 797 — but no person shall compound a drug that is essentially a copy of an approved drug unless the board has determined a shortage or a patient is allergic to the approved product, nor a drug withdrawn as unsafe or one the FDA or the board has barred from compounding.