Healthcare Provider Details

I. General information

NPI: 1871256628
Provider Name (Legal Business Name): CARRIE ELIZABETH MONTGOMERY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MILWAUKEE AVE
LUBBOCK TX
79424-0626
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0464
  • Fax: 806-698-6710
Mailing address:
  • Phone: 806-761-0334
  • Fax: 806-785-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1019899
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: