Healthcare Provider Details

I. General information

NPI: 1164527685
Provider Name (Legal Business Name): JOANN MONTGOMERY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 WHISKEYTOWN CT
REDDING CA
96001-0227
US

IV. Provider business mailing address

1135 WHISKEYTOWN CT
REDDING CA
96001-0227
US

V. Phone/Fax

Practice location:
  • Phone: 530-245-0965
  • Fax:
Mailing address:
  • Phone: 530-245-0965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number249144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: