Provider Demographics
NPI:1568658698
Name:MONTGOMERY, JENNIFER A (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:225 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4212
Mailing Address - Country:US
Mailing Address - Phone:760-737-7324
Mailing Address - Fax:
Practice Address - Street 1:225 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4212
Practice Address - Country:US
Practice Address - Phone:866-228-2236
Practice Address - Fax:760-737-7324
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3656363A00000X
CA19881363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant