Provider Demographics
NPI:1700377066
Name:MONTGOMERY, MELISSA ANN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2401
Mailing Address - Country:US
Mailing Address - Phone:918-338-3740
Mailing Address - Fax:198-338-3742
Practice Address - Street 1:3450 E FRANK PHILLIPS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2401
Practice Address - Country:US
Practice Address - Phone:918-338-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78204363LF0000X
OK105844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily