Nurse practitioners take a national board certification exam after completing their graduate nursing program. The specific test depends on your specialty, but most NPs sit for an exam administered by one of two major certification boards: the American Academy of Nurse Practitioners Certification Board (AANPCB) or the American Nurses Credentialing Center (ANCC). Passing this exam is required for state licensure and insurance credentialing.
The Two Main Certification Boards
The AANPCB and ANCC are the two organizations that certify the majority of nurse practitioners in the United States. Both boards offer exams for family nurse practitioners (FNP) and adult-gerontology primary care nurse practitioners (AGPCNP), so if you’re pursuing one of those tracks, you can choose which board to test with. The exams are not interchangeable in format, but both are recognized by all 50 state nursing boards, Medicare, Medicaid, the VA, and private insurers.
The AANPCB also offers certification for emergency nurse practitioners. The ANCC covers a broader range of specialties, including adult-gerontology acute care and psychiatric-mental health nurse practitioners. If your specialty is only offered by one board, the decision is made for you.
Specialty Exams Beyond AANPCB and ANCC
Not every NP specialty falls under those two boards. Pediatric nurse practitioners take their certification exam through the Pediatric Nursing Certification Board (PNCB), which is the only accredited board for acute care pediatric NPs. Neonatal nurse practitioners are certified exclusively through the National Certification Corporation (NCC), which also handles certifications in obstetric and women’s health specialties. NCC has certified over 99,000 healthcare professionals across those fields.
What the Exam Looks Like
The structure varies slightly by board and specialty, but the format is consistent: a timed, computer-based, multiple-choice exam taken at a testing center. You apply online, then schedule your test within a window that typically spans several months.
AANPCB exams contain 150 questions. Of those, 135 are scored and 15 are unscored pretest questions being evaluated for future use. You won’t know which questions are which. The ANCC family nurse practitioner exam also has 150 questions, broken across five content areas: assessment (19%), diagnosis (17%), planning (19%), implementation (29%), and evaluation (15%). The ANCC psychiatric-mental health NP exam is longer, with 175 questions (150 scored, 25 pretest) and a 3.5-hour time limit.
What the Exam Tests
These are not general nursing exams. They test graduate-level clinical knowledge specific to your population focus. For a family nurse practitioner, that means questions spanning patients of all ages. For a psychiatric-mental health NP, the exam covers differential diagnosis, pharmacologic and nonpharmacologic treatment, and psychotherapeutic modalities across the lifespan.
Regardless of specialty, expect heavy coverage of three core areas that every NP program is required to teach: advanced pathophysiology, advanced health assessment (including assessment of all body systems), and advanced pharmacology covering how drugs work, how the body processes them, and how to prescribe them. The exams also test health promotion, disease management, and clinical decision-making. These aren’t questions about nursing theory. They’re about what you’d actually do with a patient in front of you.
Pass Rates
First-time pass rates are reasonably high for candidates coming out of accredited programs. ANCC reported 2024 pass rates of 83% for both the family NP and adult-gerontology acute care NP exams, and 85% for the adult-gerontology primary care NP exam. The family NP exam is by far the most popular, with 7,751 first-time test takers in 2024 through ANCC alone, and over 102,000 actively certified FNPs holding ANCC credentials.
Exam Fees
AANPCB charges $240 for members of the American Association of Nurse Practitioners and $315 for non-members. If you prefer a paper application, add $50. Retake fees are the same. ANCC fees are in a similar range. These costs are separate from your graduate program tuition and your state licensure application fee.
Prerequisites Before You Can Test
You can’t simply sign up for an NP certification exam. You need an active, unrestricted RN license, which means you passed the NCLEX-RN at some earlier point in your career. You also need a Bachelor of Science in Nursing and completion of a graduate NP program at the master’s or doctoral level. Your program must include a minimum number of faculty-supervised clinical hours (at least 500 for the PMHNP track, for example, with other specialties requiring similar or higher thresholds). The certification board will verify your educational credentials before granting you a testing window.
Certification vs. State Licensure
Passing the national certification exam and getting a state NP license are two separate steps, though one depends on the other. The certification boards (AANPCB, ANCC, PNCB, NCC) issue a national credential. Your state board of nursing then uses that credential, along with your application, to grant you the authority to practice as a nurse practitioner in that state. The certification board does not automatically notify your state board of your results. You request verification to be sent to your state board of nursing as a separate step after passing.
Keeping Your Certification Active
Certification isn’t permanent. Through the AANPCB, you recertify every five years. The requirements include a minimum of 1,000 practice hours as an NP in your certified specialty during that five-year period, plus 100 contact hours of continuing education. At least 25 of those CE hours must be in advanced pharmacology. Meet those requirements and you renew without retesting. Fall short, and you may need to sit for the exam again.