Provider Demographics
NPI:1669887774
Name:MONTAGUE, CRYSTAL JENITA (NP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:JENITA
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3822 N ELM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2596
Mailing Address - Country:US
Mailing Address - Phone:336-505-9494
Mailing Address - Fax:336-419-4488
Practice Address - Street 1:4154 MENDENHALL OAKS PKWY STE 103
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8426
Practice Address - Country:US
Practice Address - Phone:336-905-8011
Practice Address - Fax:336-905-8097
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006943363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily