At a Physician Owned Medi-Spa, is a Registered Nurse Allowed to Administer Botox Without Ever Being Evaluated or Seen by the M.D

That's depends on the state you live in.  In Florida, Botox can only be done by a Physician or a Nurse Practioner / Physician's Assistant.  A nurse is not allowed to inject Botox.  Unfortuantely, a lot of Med Spas don't adhere to this.

As you can tell, each state is different. The tightest standards have come from states like NY, NJ, CA and FL, where supply and demand dictate legislation sooner than states like where I practice in Wisconsin.  It's embarrassing to even write this, but in WI a nurse can do the injections as long as they are "under supervision", a term that is not defined.  And that supervision can take place with a medical director that is within 100 miles of the clinic dispensing botox.  That supervising doc can be an MD in nearly any field.  Its crazy, and unfortunate.  That's why we continue to push for legislation for stricter supervision, and by medical directors of the core disciplines of facial plastic surgery, general plastic surgery, oculoplastic surgery, and dermatology.

This is a State dependent question.  The best way to look it up in California is to review the CA Board of Nursing website.  In Florida, injection of Botox and/or fillers is deemed the practice of Medicine and an RN is not allowed to perform these procedures even when a Physician is present.  NP's and PA's are allowed to perform these procedures under protocols written and reviewed by the supervising Physician.  Aside from all of this, most consumers/ patients prefer that a Board Certified Facial Plastic Surgeon, Plastic Surgeon or Dermatologist perform this procedure themselves.