Healthcare Provider Details

I. General information

NPI: 1699547810
Provider Name (Legal Business Name): PATRICIA ANN MONTGOMERY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHERRY ST
DARLINGTON SC
29532-3904
US

IV. Provider business mailing address

1043 HIGHWAY 576
MARION SC
29571-8336
US

V. Phone/Fax

Practice location:
  • Phone: 843-968-8120
  • Fax: 843-968-8301
Mailing address:
  • Phone: 843-503-1209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27980
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: