Provider Demographics
NPI:1053643866
Name:CORSON, HILLARY L (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:HILLARY
Middle Name:L
Last Name:CORSON
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 SW 105TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8800
Mailing Address - Country:US
Mailing Address - Phone:971-245-1332
Mailing Address - Fax:503-641-5179
Practice Address - Street 1:6600 SW 105TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8800
Practice Address - Country:US
Practice Address - Phone:971-245-1332
Practice Address - Fax:503-641-5179
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT29038363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT00Medicaid