Nurse Practitioner Salary in Virginia 2026,
$127,810 Median | BLS Data by City

Virginia nurse practitioners earn a median $127,810 a year, $61.45 an hour, per BLS OEWS May 2025, with the middle half between $109,180 and $139,500 and a full range of $99,990 to $161,470. That is 3.4% below the $132,300 national median.

Charlottesville at $142,950 by a wide margin, then Roanoke at $134,920, Winchester at $130,700, Richmond at $127,820 and Staunton-Stuarts Draft at $125,710. Academic and regional systems in smaller markets recruiting from a thin local pool is what puts Charlottesville more than fifteen thousand dollars above the statewide figure.

Eventually. Virginia is a transitional practice state: an NP works under a patient care team agreement with a physician and, after a required period of full-time clinical experience in the practice category, may apply to the Board of Nursing for autonomous practice authority. It is neither a full practice authority state nor a strictly supervisory one, and the distinction matters for anyone planning to open an independent practice here.

Partly the practice framework. A location quotient of 0.83 shows Virginia employs relatively few nurse practitioners per capita, and the patient care team requirement raises the cost to an employer of adding an NP, which suppresses the demand that would otherwise bid pay up. Add a state whose largest and highest-paying labour market is counted inside a multi-state metro, and the result is a $127,810 median against a $132,300 national figure.

Virginia's income tax reaches its 5.75% top rate at seventeen thousand dollars of taxable income, so a $127,810 salary is taxed at an effectively flat state rate with no local income tax anywhere in Virginia. NPs working across the line in the District of Columbia or Maryland are taxed where they earn, with a Virginia credit, and both of those jurisdictions layer on charges Virginia does not.

It changes the sequencing. In a full practice authority state a new NP can, in principle, build an independent practice from the start. In Virginia the first years are spent under a patient care team agreement accumulating the clinical experience required before autonomous practice authority can be sought, so the practical route runs through employment with a health system or physician group. That is not necessarily worse — it comes with structure, mentorship and benefits — but it means an independent Virginia practice is a mid-career project rather than an early one.

The occupation code covers primary care, psychiatric, acute care and specialty practice as though they were one job, and the $99,990 to $161,470 band is mostly that mix rather than a progression. The published figure also excludes productivity and panel-size incentives, which Virginia's larger systems use extensively, and it does not show the practice agreement arrangement itself — which, in the years before autonomous authority, is a real part of the economics of an NP job in this state.

Specialty and scarcity. Psychiatric mental health practice is the clearest premium in Virginia, followed by acute and critical care and procedural specialties; primary care sits at or below the $127,810 median even with a full panel. After that, geography works backwards from the usual expectation: Southwest Virginia, Southside and the Eastern Shore pay above their cost of living because they cannot recruit, and the academic centres in Charlottesville and Roanoke pay above Richmond for the same reason. Autonomous practice authority itself does not raise an employed salary directly, but it widens the jobs you can take.