Provider Demographics
NPI:1609295922
Name:MONTGOMERY, HOLLY ANN (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:HARGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1525 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5076
Mailing Address - Country:US
Mailing Address - Phone:501-758-1530
Mailing Address - Fax:501-819-6171
Practice Address - Street 1:1525 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5076
Practice Address - Country:US
Practice Address - Phone:501-758-1530
Practice Address - Fax:501-819-6171
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-10823208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program