Provider Demographics
NPI:1134527237
Name:MONTGOMERY, PAMELA GRAY (NP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:GRAY
Last Name:MONTGOMERY
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Gender:F
Credentials:NP
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Mailing Address - Street 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7364
Mailing Address - Fax:502-568-7136
Practice Address - Street 1:73 WHITE BRIDGE RD STE 103-243
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1444
Practice Address - Country:US
Practice Address - Phone:615-673-6737
Practice Address - Fax:800-474-4039
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2020-10-19
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Provider Licenses
StateLicense IDTaxonomies
TN19373363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology