Provider Demographics
NPI:1033264007
Name:MONTGOMERY, KYMBERLEE A (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KYMBERLEE
Middle Name:A
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:A
Other - Last Name:ELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1601 CHERRY ST STE 1012
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1320
Mailing Address - Country:US
Mailing Address - Phone:267-359-5638
Mailing Address - Fax:
Practice Address - Street 1:216 N BROAD ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1121
Practice Address - Country:US
Practice Address - Phone:215-762-3600
Practice Address - Fax:215-762-4323
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN295794L163W00000X
PAVP003479G363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS78805Medicare UPIN
PA026602Medicare PIN
NJ050362Medicare PIN