=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164345179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXIS JEAN MONTGOMERY FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2026
-----------------------------------------------------
Last Update Date | 08/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2009 BROWN ST
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46016-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-574-1254
-----------------------------------------------------
Fax | 317-674-0060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 697 PRO MED LN
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-5323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-574-1254
-----------------------------------------------------
Fax | 317-674-0060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 71018456A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------