Provider Demographics
NPI:1316223332
Name:MONTGOMERY, PATRICIA RENAE (RN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:RENAE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7504 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-5502
Mailing Address - Country:US
Mailing Address - Phone:832-658-5260
Mailing Address - Fax:
Practice Address - Street 1:7504 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5502
Practice Address - Country:US
Practice Address - Phone:832-658-5260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2370497163W00000X, 363LF0000X, 363LF0000X
TX1082109163W00000X, 363LF0000X, 363LF0000X
IL209009210363LF0000X
IN28253716A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse