Provider Demographics
NPI:1770989576
Name:MONTGOMERY, KRISTEN SUE (PHD CNM)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 ANTRIM AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9154
Mailing Address - Country:US
Mailing Address - Phone:843-861-3131
Mailing Address - Fax:
Practice Address - Street 1:274 BIG A RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6002
Practice Address - Country:US
Practice Address - Phone:706-886-3169
Practice Address - Fax:706-282-5371
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC606176B00000X
GARN243094176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife