Healthcare Provider Details

I. General information

NPI: 1053528760
Provider Name (Legal Business Name): TERRENCE J MONTGOMERY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BELL ROCK PLZ
SEDONA AZ
86351-8810
US

IV. Provider business mailing address

PO BOX 21540
SEDONA AZ
86341-1540
US

V. Phone/Fax

Practice location:
  • Phone: 928-204-4999
  • Fax:
Mailing address:
  • Phone: 928-204-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2648
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: