Provider Demographics
NPI:1699755314
Name:MONTGOMERY, SONYA MINTES (MSN FNP CS PMHCNS-BC)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:MINTES
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MSN FNP CS PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 ZILLICOA ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1079
Mailing Address - Country:US
Mailing Address - Phone:828-254-9494
Mailing Address - Fax:
Practice Address - Street 1:158 ZILLICOA ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1079
Practice Address - Country:US
Practice Address - Phone:828-254-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201440035826122363L00000X
NC017226502363L00000X
NC201440363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1054617OtherCIGNA
NC60093OtherBCBS
NC09436000OtherMEGALLAN
NC6113035Medicaid
NC6113035Medicaid