MEDICARE: JENNIFER MONTGOMERY PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1467824300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MONTGOMERY PA-C

Provider Business Mailing Address
First Line	:	761 TANK BATTALION
Second Line	:	BUILDING 2245
City	:	FORT HOOD
State	:	TX
Zip	:	76544-4906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	761 TANK BATTALION
Second Line	:	BUILDING 2245
City	:	FORT HOOD
State	:	TX
Zip	:	76544-4906
Country	:	US
Telephone Number	:	254-287-5410
Fax Number	:

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

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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