Provider Demographics
NPI:1295544187
Name:MONTGOMERY, DONNA JEAN (PHD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:608 8TH AVE UNIT 60
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-6695
Mailing Address - Country:US
Mailing Address - Phone:308-440-8467
Mailing Address - Fax:
Practice Address - Street 1:2715 I AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3771
Practice Address - Country:US
Practice Address - Phone:308-440-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator