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General NPI Number Information
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NPI Number | 1629200902
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Entity Type | Individual
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Provider Name | KATHLEEN JO MONTGOMERY CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 3620 COURT DRIVE
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City | ZANESVILLE
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State | OH
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Zip | 43701
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Country | US
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Telephone | 740-454-1248
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Fax | 740-454-8183
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Provider Business Mailing Address
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Address Line | P. O. BOX 1821
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City | ZANESVILLE
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State | OH
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Zip | 43702-1821
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Country | US
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Telephone | 740-455-3304
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Fax | 740-455-3686
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN241205
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | COA.10766-NP
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License Number State | OH
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