Updated June 2026 · 11 min read
What NPs actually earn by specialty, state, and setting — plus the honest comparison to CRNA and the ceiling most NPs hit earlier than they expect.
| NP Specialty | Annual Salary Range | Median | Setting |
|---|---|---|---|
| Acute Care NP (ACNP) | $125,000–$165,000 | $142,000 | ICU, hospital medicine, hospitalist |
| Psychiatric / Mental Health NP (PMHNP) | $125,000–$175,000 | $148,000 | Inpatient psych, outpatient behavioral health, telepsych |
| Emergency NP (ENP) | $130,000–$185,000 | $152,000 | Emergency department, urgent care |
| Neonatal NP (NNP) | $115,000–$155,000 | $134,000 | Level III/IV NICU |
| Pediatric NP (PNP) | $110,000–$145,000 | $125,000 | Pediatric hospital, outpatient clinic |
| Family NP (FNP) | $110,000–$145,000 | $124,000 | Primary care, urgent care, rural health |
| Adult-Gerontology NP (AGNP) | $112,000–$148,000 | $128,000 | Geriatrics, internal medicine, long-term care |
| Women's Health NP (WHNP) | $105,000–$140,000 | $118,000 | OB/GYN, reproductive health |
| Oncology NP | $115,000–$155,000 | $132,000 | Cancer centers, infusion clinics |
| Orthopedic NP | $110,000–$148,000 | $125,000 | Orthopedic surgery, sports medicine |
| Dermatology NP | $115,000–$160,000 | $135,000 | Private derm practice, med spa |
| Cardiology NP | $120,000–$158,000 | $136,000 | Cardiology group, heart failure clinic |
Psychiatric NPs (PMHNP) have seen the fastest salary growth of any NP specialty because the mental health provider shortage is severe and accelerating. The ability to prescribe psychiatric medications independently (in full-practice-authority states) means a PMHNP can run a panel of patients without physician oversight. Telepsych has further increased PMHNP income potential — many work two jobs simultaneously through different telepsych platforms, effectively doubling their patient panel and income.
Emergency NPs earn at the high end because the ED is a high-acuity environment that demands procedural skills (intubation, chest tubes, central lines in some settings) and fast clinical decision-making. Freestanding emergency centers have expanded significantly and often pay premium rates to attract experienced ENPs.
| State | Median NP Salary | Practice Authority | Notes |
|---|---|---|---|
| California | $155,000–$185,000 | Full (since 2023) | Highest NP pay in US; high COL offsets gains |
| New York | $140,000–$170,000 | Full | NYC premium; strong hospital NP market |
| Washington | $135,000–$162,000 | Full | Strong demand; tech-sector health benefit plans pay well |
| Massachusetts | $132,000–$160,000 | Full | Academic medical centers pull rates up |
| Texas | $118,000–$145,000 | Reduced (requires collaborating physician) | No state income tax; large market |
| Florida | $115,000–$140,000 | Full | Strong demand; no state income tax |
| Arizona | $118,000–$145,000 | Full | Phoenix metro market strong; rural AZ pays less |
| Tennessee | $110,000–$135,000 | Full | Low cost of living; purchasing power competitive |
| Midwest avg | $112,000–$138,000 | Mixed | Ohio, Michigan, Indiana; below national median |
In full-practice-authority (FPA) states, NPs can evaluate, diagnose, and treat patients and prescribe medications without physician supervision or a collaborative agreement. As of 2026, 29 states and DC have full practice authority for NPs.
FPA states generally pay NPs more because NPs can operate independently — opening their own practice, working at rural clinics without a physician on-site, or contracting directly with health systems at a provider-level rate. In reduced-practice states, NPs must maintain a collaborative agreement with a physician, which typically means working within a health system rather than independently. That limits both income ceiling and career options.
The income jump from staff RN to NP is significant in the early years of an NP career. A staff ICU nurse earning $88,000/year who transitions to an acute care NP role can expect $125,000–$145,000 — a $37,000–$57,000 annual increase. This more than offsets the cost of an NP program in 2–3 years for most nurses.
However, the NP school investment is lower-risk than CRNA school because: many NP programs allow part-time enrollment while working, tuition is lower ($40,000–$85,000 vs $80,000–$130,000 for CRNA), and lost income is minimal if you continue working as a nurse during the program.
The NP pay ceiling in most employed settings is $155,000–$175,000. Reaching the top of that range typically requires 10+ years of experience, a specialty certification, and a competitive market. Most NPs reach their ceiling earlier than they expect — often within 5–7 years — because the clinical ladder for NPs is shorter than for physicians.
Nurses who want income above $175,000 without starting a private practice typically end up looking at CRNA ($215,000–$250,000 starting), locum NP work (premium rates but no benefits), or medical director/leadership roles (which often pay less per hour than clinical NP work despite the title increase).
Psychiatric NPs can work for multiple telepsych platforms simultaneously in most states. Platforms like Talkiatry, Teladoc, Cerebral, and Done pay $80–$130/hour for independent contractor telepsych work. An NP with a PMHNP and a full-time hospital NP job can add $2,000–$5,000/month from 20 hours of telepsych per month. This is the highest-dollar-per-hour NP side income currently available that doesn't require patient travel or procedure setup.
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