Provider Demographics
NPI:1932667946
Name:MONTGOMERY, SAMANTHA DAWN (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DAWN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:DAWN
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:823 SW MULVANE ST FL 4
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1764
Mailing Address - Country:US
Mailing Address - Phone:785-354-6992
Mailing Address - Fax:785-354-6122
Practice Address - Street 1:823 SW MULVANE ST FL 4
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1764
Practice Address - Country:US
Practice Address - Phone:785-354-6992
Practice Address - Fax:785-354-6122
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78833363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner