Healthcare Provider Details

I. General information

NPI: 1053643866
Provider Name (Legal Business Name): HILLARY L CORSON APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 SW 105TH AVE STE 120
BEAVERTON OR
97008-8800
US

IV. Provider business mailing address

5441 S MACADAM AVE STE R
PORTLAND OR
97239-6106
US

V. Phone/Fax

Practice location:
  • Phone: 971-245-1332
  • Fax: 503-641-5179
Mailing address:
  • Phone: 406-671-8501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number100541
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202100980NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61163183
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: