MEDICARE: MS. CRYSTAL JENITA MONTAGUE N.P.

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	363LF0000X	Family Nurse Practitioner	5006943	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5006943	NC

General Provider Information

NPI Number	:	1669887774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL JENITA MONTAGUE N.P.

Provider Business Mailing Address
First Line	:	3822 N ELM ST STE 101
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2596
Country	:	US
Telephone Number	:	336-505-9494
Fax Number	:	336-419-4488

Provider Business Practice Location Address
First Line	:	4154 MENDENHALL OAKS PKWY STE 103
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8426
Country	:	US
Telephone Number	:	336-905-8011
Fax Number	:	336-905-8097

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

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	12/09/2025

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