Healthcare Provider Details

I. General information

NPI: 1013674225
Provider Name (Legal Business Name): HILARY NELSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 STONERIDGE DR # A2
BOZEMAN MT
59718-7047
US

IV. Provider business mailing address

822 STONERIDGE DR # A2
BOZEMAN MT
59718-7047
US

V. Phone/Fax

Practice location:
  • Phone: 406-551-8001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103727
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number103727
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: