Healthcare Provider Details

I. General information

NPI: 1215620026
Provider Name (Legal Business Name): TIFFANY MONIQUE MONTGOMERY PHD, RNC-OB, C-EFM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 PRESTON RD APT 1134
PLANO TX
75093-7435
US

IV. Provider business mailing address

PO BOX 260222
PLANO TX
75026-0222
US

V. Phone/Fax

Practice location:
  • Phone: 972-482-7965
  • Fax:
Mailing address:
  • Phone: 972-482-7965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number1089899
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number1089899
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number1089899
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number1089899
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: