Healthcare Provider Details

I. General information

NPI: 1649854118
Provider Name (Legal Business Name): CHELSEA NOELLE MONTGOMERY CRNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

4190 BELFORT RD STE 352
JACKSONVILLE FL
32216-1407
US

V. Phone/Fax

Practice location:
  • Phone: 904-372-3943
  • Fax: 904-212-1618
Mailing address:
  • Phone: 904-372-3943
  • Fax: 904-212-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-145450
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: