Provider Demographics
NPI:1093595415
Name:MONTGOMERY, BRITTANY RENEE (NP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:RENEE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:RENEE
Other - Last Name:BEATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6845 E US HIGHWAY 36 STE 600
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8132
Practice Address - Country:US
Practice Address - Phone:317-272-4920
Practice Address - Fax:317-272-4906
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014369A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264430I46OtherMEDICARE PTAN
IN300082041Medicaid