Healthcare Provider Details

I. General information

NPI: 1669887774
Provider Name (Legal Business Name): CRYSTAL JENITA MONTAGUE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4154 MENDENHALL OAKS PKWY STE 103
HIGH POINT NC
27265-8426
US

IV. Provider business mailing address

3822 N ELM ST STE 101
GREENSBORO NC
27455-2596
US

V. Phone/Fax

Practice location:
  • Phone: 336-905-8011
  • Fax: 336-905-8097
Mailing address:
  • Phone: 336-505-9494
  • Fax: 336-419-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5006943
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5006943
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: