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Individual

KATHLEEN JO MONTGOMERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
3620 COURT DRIVE, ZANESVILLE, OH 43701
(740) 454-1248
(740) 454-8183
Mailing address
P. O. BOX 1821, ZANESVILLE, OH 43702-1821
(740) 455-3304
(740) 455-3686

Taxonomy

Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
RN241205
OH
363L00000X
Nurse Practitioner
Primary
COA.10766-NP
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3026988
OH
05
3810019285
WV
01
P00914840
RR MEDICARE
OH
Enumeration date
08/20/2009
Last updated
05/23/2011
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