Provider Demographics
NPI:1255480489
Name:MONTGOMERY, LAUREN B (CRNA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 FLOWOOD DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9307
Mailing Address - Country:US
Mailing Address - Phone:601-933-9521
Mailing Address - Fax:601-933-9525
Practice Address - Street 1:2550 FLOWOOD DR STE 400
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9307
Practice Address - Country:US
Practice Address - Phone:601-933-9521
Practice Address - Fax:601-933-9525
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865709367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered