=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225447519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTEN ANN MONTGOMERY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2014
-----------------------------------------------------
Last Update Date | 12/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 HARRODSBURG RD SUITE A-540
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40504-3751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-258-6760
-----------------------------------------------------
Fax | 859-258-6512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 LEXINGTON GREEN CIR STE 600
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40503-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-971-4695
-----------------------------------------------------
Fax | 859-971-4604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | TC299
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------