Healthcare Provider Details

I. General information

NPI: 1720643554
Provider Name (Legal Business Name): LAKISHA EVETTE MONTGOMERY APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 W WALNUT HILL LN STE 102
IRVING TX
75038-3270
US

IV. Provider business mailing address

13052 DALLAS PKWY STE 210
FRISCO TX
75033-4241
US

V. Phone/Fax

Practice location:
  • Phone: 940-843-1455
  • Fax: 972-535-0441
Mailing address:
  • Phone: 940-365-9001
  • Fax: 940-365-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP141093
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: