Healthcare Provider Details

I. General information

NPI: 1881925154
Provider Name (Legal Business Name): KERI MONTGOMERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERI CREWS

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WOODLAND ROAD SUITE 304
ST. HELENA CA
94574
US

IV. Provider business mailing address

6 WOODLAND ROAD SUITE 304
ST. HELENA CA
94574
US

V. Phone/Fax

Practice location:
  • Phone: 707-963-7200
  • Fax: 707-963-7203
Mailing address:
  • Phone: 707-963-7200
  • Fax: 707-963-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number203144
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0000068-C-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991663-NP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012403
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number95012403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: