Provider Demographics
NPI:1568476182
Name:MONTGOMERY, JAMES CRAIG (FNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CRAIG
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 W LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-3904
Mailing Address - Country:US
Mailing Address - Phone:865-273-0008
Mailing Address - Fax:865-895-4090
Practice Address - Street 1:616 W LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3904
Practice Address - Country:US
Practice Address - Phone:865-273-0008
Practice Address - Fax:865-895-4090
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7956363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341110Medicare PIN