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 1:5441 S MACADAM AVE STE R
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6106
Mailing Address - Country:US
Mailing Address - Phone:406-671-8501
Mailing Address - Fax:
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:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100541363LP0808X
OR202100980NP-PP363LP0808X
WAAP61163183363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT00Medicaid