Healthcare Provider Details

I. General information

NPI: 1427059559
Provider Name (Legal Business Name): HEATHER JEAN MONTGOMERY C.R.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 STOAKLEY ROAD SUITE 300
PRINCE FREDERICK MD
20678
US

IV. Provider business mailing address

PO BOX 1540
PRINCE FREDERICK MD
20678-1540
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4561
  • Fax: 410-535-9941
Mailing address:
  • Phone: 410-535-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR137571
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR137571
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: