Provider Demographics
NPI:1811010580
Name:MONTGOMERY, JO LEAH (CRNFA)
Entity Type:Individual
Prefix:
First Name:JO LEAH
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:JO LEAH
Other - Middle Name:C
Other - Last Name:BIRCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 660046
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0046
Mailing Address - Country:US
Mailing Address - Phone:214-369-8555
Mailing Address - Fax:
Practice Address - Street 1:3108 MIDWAY RD
Practice Address - Street 2:STE 104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6383
Practice Address - Country:US
Practice Address - Phone:214-781-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX623984163W00000X, 163WR0006X, 163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N8090OtherBCBS