Provider Demographics
NPI:1770032369
Name:MONTGOMERY, MEGAN (RD, LD, CD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RD, LD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 WILLOW STREAM CT
Mailing Address - Street 2:APT 204
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5984
Mailing Address - Country:US
Mailing Address - Phone:859-704-0268
Mailing Address - Fax:
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:859-704-0268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY124509133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered