Provider Demographics
NPI:1720643554
Name:MONTGOMERY, LAKISHA EVETTE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:EVETTE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13052 DALLAS PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4241
Mailing Address - Country:US
Mailing Address - Phone:940-365-9001
Mailing Address - Fax:940-365-9009
Practice Address - Street 1:13052 DALLAS PKWY STE 210
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4241
Practice Address - Country:US
Practice Address - Phone:940-365-9001
Practice Address - Fax:940-365-9009
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP141093363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX834487Medicaid