Provider Demographics
NPI:1508373622
Name:MONTGOMERY, BRITTANI BRIANA NICOLE
Entity Type:Individual
Prefix:MS
First Name:BRITTANI
Middle Name:BRIANA NICOLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BOXMERE PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6101
Mailing Address - Country:US
Mailing Address - Phone:915-471-4614
Mailing Address - Fax:
Practice Address - Street 1:1900 BELMONT BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3758
Practice Address - Country:US
Practice Address - Phone:915-471-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35088183700000X
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35088OtherPHARMACY INTERN LICENSE