Provider Demographics
NPI:1306155601
Name:MONTGOMERY, WHITNEY LANE (PA-C)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LANE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4015 IH 45 SOUTH
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-270-3900
Mailing Address - Fax:
Practice Address - Street 1:4015 IH 45 SOUTH
Practice Address - Street 2:SUITE 110
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-270-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02593363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DH856OtherBCBSTX PROVIDER RECORD #
TX0035TDOtherBLUE BLUE SHIELD OF TEXAS GRP PROVIDER RECORD NUMBER
TX00659NOtherMEDICARE GRP PTAN - MONTGOMERY CO.
TX219982003Medicaid
TX00106WOtherMEDICARE GRP PTAN - HARRIS CO.
TX153449704OtherMEDICAID GRP TPI - HARRIS CO.