Healthcare Provider Details

I. General information

NPI: 1699755314
Provider Name (Legal Business Name): SONYA MINTES MONTGOMERY MSN FNP CS PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 ZILLICOA ST
ASHEVILLE NC
28801-1079
US

IV. Provider business mailing address

158 ZILLICOA ST
ASHEVILLE NC
28801-1079
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-9494
  • Fax:
Mailing address:
  • Phone: 828-254-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201440035826122
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number017226502
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201440
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: