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General NPI Number Information
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NPI Number | 1871728436
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Entity Type | Individual
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Provider Name | RENA D MONTGOMERY APN
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Gender | Female
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 125 GUTHRIE DR
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5829
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Country | US
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Telephone | 901-252-3400
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Fax | 901-763-4305
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Provider Business Mailing Address
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Address Line | 1325 WOLF PARK DR STE 103
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City | GERMANTOWN
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State | TN
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Zip | 38138-1759
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Country | US
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Telephone | 901-252-3400
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Fax | 901-763-4305
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN14046
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 364SW0102X
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Taxonomy Name | Women's Health Clinical Nurse Specialist
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License Number | APN14046
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License Number State | TN
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