Nurse Practitioner Hourly Pay (2026): How Much Do NPs Make Per Hour?

Nurse practitioner hourly pay varies dramatically by population focus, state practice authority, compensation model, and 1099 vs W-2 structure. The national median sits at $65.80/hour, but PMHNP and AGACNP hourly rates reach $117.87+ in top markets like Sunnyvale, CA and exceed $120/hour in 1099 telehealth psychiatric practice.

This guide breaks down the five biggest drivers of NP hourly pay differences across 1684+ U.S. metropolitan areas. Whether you're a new ANCC / AANP board-certified graduate selecting first specialty, a working NP considering 1099 vs staff, or a clinic administrator benchmarking competitive NP wages, the framework below is the central reference.

1. Specialty / Population Focus: PMHNP / AGACNP Drive Top Pay

Population focus drives the largest single variation in NP hourly pay:

• PMHNP (Psychiatric Mental Health NP) — top NP specialty driven by structural psychiatric provider shortage. Staff $70–$100/hour, telehealth $80–$160/hour, 1099 independent $120–$220/hour. Strong markets: California, NY, Texas, Florida (all major metros). Buprenorphine X-waiver and DEA Schedule II prescribing supports SUD-treatment premium.
• AGACNP (Adult-Gerontology Acute Care) — hospitalist / ICU NPs at $80–$120/hour staff. Strong demand at all academic medical centers.
• FNP (Family NP) — most common NP specialty. Primary care $55–$80/hour staff. Family medicine clinics, urgent care, retail clinics, FQHCs.
• WHNP (Women's Health NP) — OB/GYN clinics, family planning, fertility. $60–$90/hour staff.
• PNP-PC / PNP-AC (Pediatric NP — Primary Care / Acute Care) — pediatric primary care vs pediatric hospitalist.
• NNP (Neonatal NP) — top-tier NP specialty at NICU level III/IV centers. $80–$130/hour staff plus call structure.
• AGPCNP (Adult-Gerontology Primary Care) — internal medicine clinics, primary care groups.
• Aesthetics / cosmetic NP — Botox / fillers / weight management. 1099 model bills $120–$200+/hour in HNW markets.
• Weight management / GLP-1 NP — rapidly emerging segment with Ozempic / Wegovy / Mounjaro prescribing. Strong telehealth and cash-pay opportunity.
• Cardiology / oncology / dermatology specialty NPs — strong RVU productivity at specialty groups.

2. State Practice Authority: FPA vs Reduced vs Restricted

State NP practice authority directly affects pay because broader scope enables independent / 1099 practice:

• Full Practice Authority (FPA, 27+ states) — Alaska, Arizona, Colorado, Connecticut, Delaware, DC, Hawaii, Idaho, Iowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington, Wyoming. FPA enables fully independent NP practice without physician supervision.
• Reduced Practice Authority (12 states) — requires collaborative agreement with physician for at least one element of practice.
• Restricted Practice Authority (12 states) — requires physician supervision for all NP practice. Includes Texas, Florida, California (transitioning), Georgia, Tennessee, North Carolina.
• VA system national FPA — VA has implemented full practice authority for NPs across all VA facilities regardless of state law.

3. State and Metro Cost-of-Living

Location drives nominal NP hourly pay:

• California ($65–$95/hour staff) — Bay Area, LA, San Diego markets lead despite restricted practice authority.
• Alaska, Hawaii, Washington, Massachusetts ($60–$85/hour staff) — high COL plus FPA in WA/MA/AK supports independent practice.
• New York, New Jersey, Connecticut ($55–$80/hour staff) — NY FPA supports independent practice.
• Texas, Florida, Tennessee, Nevada (no state tax) — strong take-home despite lower nominal.

4. Compensation Model: Salary / RVU / Hourly / 1099

Compensation model drives 20–80% variation:

• Flat salary — most primary care NPs.
• Salary + RVU productivity — most specialty NPs (cardiology, dermatology, surgical specialty).
• Hourly + shift differential + on-call — EM NP, hospitalist NP, NNP.
• Pure 1099 contractor — psychiatric NPs, aesthetics NPs, telehealth NPs in FPA states. Highest effective hourly.
• Locum tenens — premium hourly + travel + housing. PMHNP, EM NP, hospitalist NP locum at $90–$220/hour.

5. Experience and Specialty Path

Experience progression and specialty board credentials drive premium:

• New graduate NP ($55–$70/hour starting) — fresh ANCC / AANP board-certified.
• 2–5 year NP ($60–$80/hour) — most reach state median.
• 5–10 year NP ($70–$95/hour) — senior staff with specialty experience.
• 10+ year NP ($80–$120+/hour staff) — established with leadership / 1099 options.
• DNP (Doctor of Nursing Practice) — increasingly common entry credential.
• NCC specialty credentials — additional subspecialty certifications.
• State buprenorphine X-waiver / Schedule II prescribing — supports SUD-treatment and pain-management premium.

2026 Nurse Practitioner Hourly Pay Outlook

NP pay has grown at a compound annual rate of 3.45% nationally over the past five years — driven by structural NP shortage relative to specialty demand, rapid psychiatric / mental health NP hiring at telehealth platforms, expanding FPA legislation, rising aesthetic / cosmetic NP demand, GLP-1 weight management NP demand, growing 1099 independent practice trend, and aggressive locum staffing rates. The BLS projects NP employment growth at 38% (combined APRN category) through 2033 — among the fastest-growing occupations — keeping very strong upward pressure on hourly pay especially for PMHNP / AGACNP specialty NPs.