Provider Demographics
NPI:1891402574
Name:MONTGOMERY, KRISTEN CLAY (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CLAY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 W. JAMES CAMPBELL BLVD
Mailing Address - Street 2:# 403
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-380-0075
Mailing Address - Fax:931-388-7502
Practice Address - Street 1:854 W. JAMES CAMPBELL BLVD
Practice Address - Street 2:# 403
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-380-0075
Practice Address - Fax:931-388-7502
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32693363LF0000X, 363LP2300X
TNAPN0000032693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care