Healthcare Provider Details

I. General information

NPI: 1427969922
Provider Name (Legal Business Name): JORDYN MONTGOMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 OLD WARREN RD
MONTICELLO AR
71655-9717
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 870-224-4411
  • Fax: 870-224-0925
Mailing address:
  • Phone: 870-224-4411
  • Fax: 870-224-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number221449
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: