MEDICARE: MELISSA ANN MONTGOMERY APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	78204	KS
2	363LF0000X	Family Nurse Practitioner	105844	OK

General Provider Information

NPI Number	:	1700377066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN MONTGOMERY APRN-CNP

Provider Business Mailing Address
First Line	:	3450 E FRANK PHILLIPS BLVD
Second Line	:	STE 400
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2401
Country	:	US
Telephone Number	:	918-338-3740
Fax Number	:	198-338-3742

Provider Business Practice Location Address
First Line	:	3450 E FRANK PHILLIPS BLVD STE 400
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2401
Country	:	US
Telephone Number	:	918-338-3740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	11/03/2020

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