Provider Demographics
NPI:1326759499
Name:MONTGOMERY, KESKA D
Entity Type:Individual
Prefix:
First Name:KESKA
Middle Name:D
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:NORTHFORK
Mailing Address - State:WV
Mailing Address - Zip Code:24868-0105
Mailing Address - Country:US
Mailing Address - Phone:304-308-9539
Mailing Address - Fax:
Practice Address - Street 1:23 PROMISE CIRCLE
Practice Address - Street 2:
Practice Address - City:NORTHFORK
Practice Address - State:WV
Practice Address - Zip Code:24868
Practice Address - Country:US
Practice Address - Phone:304-308-9539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant