Provider Demographics
NPI:1598100588
Name:MONTGOMERY, BETTY MARIE (CG)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:MARIE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CG
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:MARIE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CG
Mailing Address - Street 1:8301 E 105TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-2123
Mailing Address - Country:US
Mailing Address - Phone:816-606-0108
Mailing Address - Fax:
Practice Address - Street 1:8301 E 105TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-2123
Practice Address - Country:US
Practice Address - Phone:816-606-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide