Healthcare Provider Details

I. General information

NPI: 1578146783
Provider Name (Legal Business Name): COURTNEY REGINA MONTGOMERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

IV. Provider business mailing address

200 7TH AVE STE 150
SANTA CRUZ CA
95062-4669
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-4100
  • Fax: 831-454-4488
Mailing address:
  • Phone: 831-462-1060
  • Fax: 831-462-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95018193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: