Provider Demographics
NPI:1649896648
Name:MONTGOMERY, KATRINA ANTONETTE (MD)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:ANTONETTE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 DYLAN PL.
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514
Mailing Address - Country:US
Mailing Address - Phone:859-489-9665
Mailing Address - Fax:
Practice Address - Street 1:107 MERIDIAN WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2878
Practice Address - Country:US
Practice Address - Phone:859-624-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine