Provider Demographics
NPI:1114183084
Name:MONTGOMERY, JANE F (RN NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8567
Mailing Address - Street 2:
Mailing Address - City:BACLIFF
Mailing Address - State:TX
Mailing Address - Zip Code:77518-8567
Mailing Address - Country:US
Mailing Address - Phone:281-339-2213
Mailing Address - Fax:281-335-4529
Practice Address - Street 1:6417 MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-4058
Practice Address - Country:US
Practice Address - Phone:281-339-2213
Practice Address - Fax:281-335-4529
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230962363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health