Does a med spa in North Dakota need a medical director?

Short answer
The cited rules do not settle this — none requires a med spa to have a medical director; they only allow board rule to require certain advanced esthetic services be performed under the supervision or direction of a physician, PA, or advanced practice nurse.

The Medical Practice Act itself sets the terms on which a physician assistant may practice. A PA serving a patient located in the state must hold an active North Dakota PA license or be privileged under chapter 43-17.5, and the Board of Medicine sets the rules governing a PA’s conduct, licensure, qualifications and discipline. The hard limit is negative rather than positive: a PA is NOT authorized to perform any service that must be performed by someone licensed under chapters 43-12.1, 43-13, 43-15 and 43-28. On the nursing side, a nurse may supervise and delegate nursing interventions, to an individual the nursing chapter exempts under a named subsection. The cosmetology chapter answers the microneedling question in its definitions: esthetics excludes any procedure invading living tissue below the stratum corneum and excludes advanced esthetic procedures; advanced esthetics includes microneedling, nonablative procedures, advanced chemical peels and lancet extractions but not treatment of a medical ailment or ablative procedures; and an advanced esthetician must file proof of board-approved additional training before using microneedling pens, rollers or devices.