Nurse Practitioner Salaries by State

With an average annual salary of $128,490, NPs rank among the highest-paid nurses in the field. The demand for NPs continues to increase due to nurses retiring and an aging population’s growing need for healthcare.

This guide presents current compensation trends based on the most up-to-date NP salary data from the U.S. Bureau of Labor Statistics (BLS). Nurses interested in NP careers can learn about NP salaries by state, cost of living adjustments, and states with the largest changes in NP earnings.

Source: BLS, 2023

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This section uses the latest BLS data to present an overview of NP salary distribution across the U.S. Discover annual average salaries across all 50 states and a list of the highest-paying states for nurse practitioners.

NP salaries vary significantly across the country. Western and northeastern states dominate this list of the best-paying NP salaries. In contrast, southern states tend to offer the lowest salaries. California tops the list, with NPs earning an average of $161,540 annually — over $57,000 more than the lowest-paying state, Tennessee.

Urban centers tend to offer higher pay than rural areas. For example, Northern California has thetop five metropolitan areas for NPs in the country.

The cost of living plays a significant role in compensation. In states with high cost of living figures and high demand for NPs, these nurses can earn well over six figures. Southern states with lower living expenses, such as Tennessee, Alabama, and South Carolina, tend to offer lower annual salaries, ranging between $103,000 and $116,940.

Another factor that may contribute to higher earnings in some states is nursing unions. Western and northeastern states have developed stronger union movements than the southern states. Nursing unions have successfully bolstered compensation rates by negotiating for pensions and other benefits.

Most states grant NPs full practice authority, reflected in higher compensation levels. However, the lowest-paying states, including Tennessee, Alabama, South Carolina, Missouri, Kentucky, and West Virginia, have only authorized restricted or reduced practice authority. States like California that have adoptednurse-to-patient ratio laws to improve patient safety and quality care also offer higher NP salaries.

The cost of living where NPs intend to practice affects their earning potential. This table shows the top ten highest-paying states for NPs adjusted for the cost of living index.

According to the U.S. Bureau of Economic Analysis (BEA), the cost of living index (or regional price parity) measures how far your earnings will go based on the regional price of goods and services across states. The index, with 100 as the national average, takes into account the cost of essentials such as food, housing, utilities, healthcare, and transportation.

Even when adjusted for cost of living, NP earnings in all fifty states top six figures. Adjusted salaries in the top ten highest-paying states range from $137,477 to $154,222. California ranks higher than the national average for cost of living.

NPs employed in states with a higher cost of living may have to adjust their salary expectations depending on their desired standard of living and personal and family obligations.

Based on the annual average wage adjusted for cost of living, California still ranks among the top ten best-paying states for NPs, with Nevada maintaining the top ranking for the highest NP salary based on the cost of living in the country.

Overall, NP compensation has grown in almost every region of the country, with particularly large increases in Nevada and Idaho. No state experienced a decrease in the average annual salary of nurse practitioners.

The nursing shortage, an increasing aging population, and the growing rate of nurse retirements, all contribute to rising demand and compensation for NPs. As more states experience physician shortages and seek to reduce healthcare costs, they grant broader practice authority to NPs, making them more valuable to employers.