Individual
LATRENA MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
105 VARESE PL, MADISON, MS 39110
(601) 622-8182
Mailing address
1668 W PEACE ST, CANTON, MS 39046-5332
(601) 622-8182
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R881572
MS
Other
Enumeration date
06/18/2015
Last updated
12/06/2021
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