Individual
MRS. KIA DANIELLE MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
350 W WOODROW WILSON AVE STE 411, JACKSON, MS 39213-7681
(601) 432-3070
(601) 364-2659
Mailing address
350 W WOODROW WILSON AVE STE 411, JACKSON, MS 39213-7681
(601) 432-3070
(601) 364-2659
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
893817
MS
363LW0102X
Women's Health Nurse Practitioner
893817
MS
363LW0102X
Women's Health Nurse Practitioner
Primary
904981
MS
Other
Enumeration date
02/15/2020
Last updated
10/26/2021
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