Healthcare Provider Details

I. General information

NPI: 1891402574
Provider Name (Legal Business Name): KRISTEN CLAY MONTGOMERY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 W. JAMES CAMPBELL BLVD # 403
COLUMBIA TN
38401
US

IV. Provider business mailing address

854 W. JAMES CAMPBELL BLVD # 403
COLUMBIA TN
38401
US

V. Phone/Fax

Practice location:
  • Phone: 931-380-0075
  • Fax: 931-388-7502
Mailing address:
  • Phone: 931-380-0075
  • Fax: 931-388-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32693
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number32693
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000032693
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: