Provider Demographics
NPI:1972085355
Name:MONTGOMERY, TANA KAYLIENE (RN)
Entity Type:Individual
Prefix:MS
First Name:TANA
Middle Name:KAYLIENE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:TANA
Other - Middle Name:KAYLIENE
Other - Last Name:OSGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-4221
Mailing Address - Country:US
Mailing Address - Phone:979-492-6288
Mailing Address - Fax:
Practice Address - Street 1:307 S MADISON ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-4221
Practice Address - Country:US
Practice Address - Phone:979-492-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator