Provider Demographics
NPI:1104627223
Name:MONTGOMERY, KAIESHA NICOLE
Entity type:Individual
Prefix:MS
First Name:KAIESHA
Middle Name:NICOLE
Last Name:MONTGOMERY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3576
Mailing Address - Country:US
Mailing Address - Phone:800-522-6619
Mailing Address - Fax:800-522-6619
Practice Address - Street 1:5610 BROAD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3576
Practice Address - Country:US
Practice Address - Phone:800-522-6619
Practice Address - Fax:800-522-6619
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty