Provider Demographics
NPI:1790753598
Name:MONTGOMERY, ALANA G (FNP)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:G
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10100
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-0008
Mailing Address - Country:US
Mailing Address - Phone:970-874-7696
Mailing Address - Fax:970-874-6325
Practice Address - Street 1:155 STAFFORD LN
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2229
Practice Address - Country:US
Practice Address - Phone:970-874-7696
Practice Address - Fax:970-874-6325
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX512966363LP2300X
CO990845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81N529OtherBCBS
TX112253301Medicaid
TX112253301Medicaid
TX8K2675Medicare PIN