Provider Demographics
NPI:1346002151
Name:MONTGOMERY, HOLLY (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11404 W DODGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-9603
Mailing Address - Country:US
Mailing Address - Phone:402-898-1113
Mailing Address - Fax:402-918-5588
Practice Address - Street 1:11404 W DODGE RD STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-9603
Practice Address - Country:US
Practice Address - Phone:140-289-8111
Practice Address - Fax:402-819-5588
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115182363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health