Healthcare Provider Details

I. General information

NPI: 1629200902
Provider Name (Legal Business Name): KATHLEEN JO MONTGOMERY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 COURT DRIVE
ZANESVILLE OH
43701
US

IV. Provider business mailing address

P. O. BOX 1821
ZANESVILLE OH
43702-1821
US

V. Phone/Fax

Practice location:
  • Phone: 740-454-1248
  • Fax: 740-454-8183
Mailing address:
  • Phone: 740-455-3304
  • Fax: 740-455-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.10766-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN241205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: