Healthcare Provider Details

I. General information

NPI: 1689447591
Provider Name (Legal Business Name): CONNIE R SUAREZ-HICKEY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N ORANGE ST STE 202
MISSOULA MT
59802-2951
US

IV. Provider business mailing address

PO BOX 31001
PASADENA CA
91110-4110
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3362
  • Fax:
Mailing address:
  • Phone: 406-327-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023124921
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-225149
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: