MEDICARE: MS. NATASHA RADINE MONTOYA MSN, APRN, AGPCNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN174257	AZ
2	363L00000X	Nurse Practitioner	5013790	NC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	323998	AZ

General Provider Information

NPI Number	:	1194323410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NATASHA RADINE MONTOYA MSN, APRN, AGPCNP-BC

Provider Business Mailing Address
First Line	:	5859 CAMBRIDGE BAY DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-6120
Country	:	US
Telephone Number	:	702-860-2887
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 CAPITOL AVE STE 415
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4562
Country	:	US
Telephone Number	:	702-860-2887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	07/08/2025

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