Provider Demographics
NPI:1629531595
Name:MONTGOMERY, EBONY MONIQUE (APRN)
Entity type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:MONIQUE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SW 7TH ST STEA205
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:877-522-1275
Mailing Address - Fax:833-888-7145
Practice Address - Street 1:1410 BRADEN STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:870-280-2578
Practice Address - Fax:844-447-2520
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR125407363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology