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Individual
KENT MONTGOMERY
Active
Individual
KENT MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1070170
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000347212 NONPAR
ANTHEM BCBS
—
05
—
30610026
—
KY
Enumeration date
10/03/2006
Last updated
09/07/2011
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