Provider Demographics
NPI:1346658663
Name:MONTGOMERY, BARBARA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8598 HIGHWAY 22 STE 390
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-2308
Mailing Address - Country:US
Mailing Address - Phone:731-588-4000
Mailing Address - Fax:
Practice Address - Street 1:8598 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-2308
Practice Address - Country:US
Practice Address - Phone:731-588-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010393363LF0000X
TN18952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007962Medicaid
TNQ007962Medicaid