Individual provider Active NPI

Amanda Rae Holloron, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Missoula, MT
National Provider Identifier
1710598073
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
NUR-APRN-LIC-160743 Issued in MT
Practice address
2620 Connery Way
Missoula, MT 59808-1325
Phone
(406) 880-9213
NPI assigned
Aug 11, 2020
Last updated
Dec 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NUR-APRN-LIC-160743 MT Primary

Addresses

Primary practice location

2620 Connery Way
Missoula, MT 59808-1325

Mailing address

2620 Connery Way
Missoula, MT 59808-1325
Phone (406) 880-9213

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address aholloron205322@wm.providencedirect.org Direct
Direct Messaging Address aholloron205322@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NUR-APRN-LIC-160743MTMDPsychiatric/Mental Health Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: aholloron205322@wm.providencedirect.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1710598073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 CONNERY WAY",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081325",
            "telephone_number": "406-880-9213",
            "fax_number": "949-864-3190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 CONNERY WAY",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081325",
            "telephone_number": "406-880-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLORON",
        "first_name": "AMANDA",
        "middle_name": "RAE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-11",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MT",
            "license": "NUR-APRN-LIC-160743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aholloron205322@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 W Broadway St",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aholloron205322@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "900 N Orange St Ste 102",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598022951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.