Directly adjacent provinces are (from south clockwise): Mukdahan, Sakon Nakhon, and Bueng Kan. To the northeast it borders Khammouan of Laos.

During the 1960s, 73 of the 131 sub-district (tambons) were allegedly infiltrated by the Vietnamese and Lao communists, and the province was known as the "heartland of insurgency".

Towards the end of the Vietnam War, US forces moved their Indochinese military operations to Nakhon Phanom.

[citation needed] Vietnamese communist leader Ho Chi Minh had resided from 1928 and 1931 in Ban Nachok, a small village on the road between what is now the airbase and Nakhon Phanom.

[8]: xiii, 44 In 2023, a Lao 56-year-old man named Thao Bua Pa was arrested in a major bust for having 1,012,000 tablets of methamphetamine pills.

The provincial slogan is "The city of the revered Phrathat Phanom, cultural diversity, beautiful Phutai people, brilliant illuminated boat procession and picturesque Mekong River".

Important festivals in the province include the traditional dances of the Phu Thai ethnic group held in May and June every year.

This festival is held to show the richness of local aquatic resources and to raise awareness of the conservation of nature and fish species.

Padaek or Pla ra, fermented, preserved fish, originally comes from the Si Songkhram area is now popular throughout Thailand.

As of 2019[update], a commercial mixed-use project with a hotel, sports complex, healthcare and trade exhibition center, respectively, and other facilities is being constructed on a 1,335 rai site near the third Thai-Lao Friendship Bridge and Nakhon Phanom checkpoint.

As of 26 November 2019 there are:[13] one Nakhon Phanom Provincial Administration Organisation (ongkan borihan suan changwat) and 22 municipal (thesaban) areas in the province.

The non-municipal areas are administered by 81 Subdistrict Administrative Organisations - SAO (ongkan borihan suan tambon).

Highway 212 runs from Nong Khai along the Mekong River through Nakhon Phanom to Mukdahan, and then south to Ubon Ratchathani.