Individual
JAYME KENNA MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
705 W OAKLAND ST, BROKEN ARROW, OK 74012-1656
(918) 251-2666
Mailing address
8505 E 132ND ST S, BIXBY, OK 74008-3306
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
113779
OK
Other
Enumeration date
06/01/2019
Last updated
06/01/2019
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