Healthcare Provider Details

I. General information

NPI: 1891619722
Provider Name (Legal Business Name): TYLAR N MONTGOMERY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 LOCUST RD
FORT SCOTT KS
66701-8336
US

IV. Provider business mailing address

1791 LOCUST RD
FORT SCOTT KS
66701-8336
US

V. Phone/Fax

Practice location:
  • Phone: 620-644-8510
  • Fax:
Mailing address:
  • Phone: 620-644-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2026036578
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number230842
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number53-85945-012
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: