Provider Demographics
NPI:1295401263
Name:MONTGOMERY, STEPHEN MICHAEL JR (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:MONTGOMERY
Suffix:JR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
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Mailing Address - Street 1:3333 BURNET AVE., ML 3014
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4788
Mailing Address - Fax:513-636-4283
Practice Address - Street 1:5642 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-3114
Practice Address - Country:US
Practice Address - Phone:513-636-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner