Healthcare Provider Details

I. General information

NPI: 1306155601
Provider Name (Legal Business Name): WHITNEY LANE MONTGOMERY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. WHITNEY ATKINS

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 IH 45 SOUTH SUITE 110
CONROE TX
77304
US

IV. Provider business mailing address

4015 IH 45 SOUTH SUITE 110
CONROE TX
77304
US

V. Phone/Fax

Practice location:
  • Phone: 936-270-3900
  • Fax:
Mailing address:
  • Phone: 936-270-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: