Provider Demographics
NPI:1720075369
Name:MONTGOMERY-DEEM, EMILY KATHRYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KATHRYN
Last Name:MONTGOMERY-DEEM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:KATHRYN
Other - Last Name:MONTGOMERY-DEEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2619 LARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4319
Mailing Address - Country:US
Mailing Address - Phone:304-741-5984
Mailing Address - Fax:
Practice Address - Street 1:1220 LEE ST E STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1864
Practice Address - Country:US
Practice Address - Phone:304-388-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant