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General NPI Number Information
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NPI Number | 1154230688
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Entity Type | Individual
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Provider Name | PENELOPE MONTGOMERY
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Gender | Female
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 391 SOUTHCREST CIR STE 200
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6729
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Country | US
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Telephone | 901-271-1000
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Fax | 662-996-1209
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Provider Business Mailing Address
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Address Line | 391 SOUTHCREST CIR STE 200
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6729
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Country | US
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Telephone | 901-271-1000
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Fax | 662-996-1209
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 857656
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License Number State | MS
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