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Individual
WHITNEY LANE MONTGOMERY
Active
Individual
WHITNEY LANE MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02593
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00106W
MEDICARE GRP PTAN - HARRIS CO.
TX
01
—
0035TD
BLUE BLUE SHIELD OF TEXAS GRP PROVIDER RECORD NUMBER
TX
01
—
00659N
MEDICARE GRP PTAN - MONTGOMERY CO.
TX
01
—
153449704
MEDICAID GRP TPI - HARRIS CO.
TX
05
—
219982003
—
TX
01
—
8DH856
BCBSTX PROVIDER RECORD #
TX
Enumeration date
10/04/2010
Last updated
03/21/2019
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