Provider Demographics
NPI:1588266399
Name:MONTGOMERY, DEVON SHENAE (NP-C)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:SHENAE
Last Name:MONTGOMERY
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 BELL ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5714
Mailing Address - Country:US
Mailing Address - Phone:806-212-4835
Mailing Address - Fax:
Practice Address - Street 1:4510 BELL ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5714
Practice Address - Country:US
Practice Address - Phone:806-212-4835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2025-04-01
Deactivation Date:2021-06-15
Deactivation Code:
Reactivation Date:2021-07-15
Provider Licenses
StateLicense IDTaxonomies
TX1014033363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily