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General NPI Number Information
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NPI Number | 1669289252
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Entity Type | Individual
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Provider Name | KARLY MONTGOMERY PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 1100 E MICHIGAN AVE
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City | GRAYLING
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State | MI
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Zip | 49738-1312
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Country | US
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Telephone | 546-198-9348
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Fax |
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Provider Business Mailing Address
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Address Line | 825 N CENTER AVE
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City | GAYLORD
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State | MI
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Zip | 49735-1592
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Country | US
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Telephone | 989-731-2100
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601012916
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License Number State | MI
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