Provider Demographics
NPI:1912374034
Name:MONTGOMERY, HILARY DAWN (PMHNP)
Entity Type:Individual
Prefix:MISS
First Name:HILARY
Middle Name:DAWN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13203 SE 172ND AVE STE 166-233
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8737
Mailing Address - Country:US
Mailing Address - Phone:503-661-7733
Mailing Address - Fax:503-661-7890
Practice Address - Street 1:1217 NE BURNSIDE RD BLDG C
Practice Address - Street 2:STE. 503A
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-6722
Practice Address - Country:US
Practice Address - Phone:503-661-7733
Practice Address - Fax:503-661-7890
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201405166RN163WP0808X
171M00000X
OR201907881NP-PP363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator