=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720643554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAKISHA EVETTE MONTGOMERY APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2019
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1329 W WALNUT HILL LN STE 102
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75038-3270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-843-1455
-----------------------------------------------------
Fax | 972-535-0441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13052 DALLAS PKWY STE 210
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75033-4241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-365-9001
-----------------------------------------------------
Fax | 940-365-9009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP141093
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------