Provider Demographics
NPI:1801048053
Name:MONTGOMERY, KELLY ELIZABETH (ACNP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ELIZABETH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:1301 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 2665 THE VANDERBILT CLINIC
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232
Mailing Address - Country:US
Mailing Address - Phone:615-936-8422
Mailing Address - Fax:615-936-1812
Practice Address - Street 1:1301 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2665
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0028
Practice Address - Country:US
Practice Address - Phone:615-936-8422
Practice Address - Fax:615-936-1812
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13644363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care