Individual
LACRISTA MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SPECIALUST
Contact information
Practice address
811 GARFIELD ST, TUPELO, MS 38801-5748
(662) 422-6044
Mailing address
142 WOODGREEN RD APT 23, PLANTERSVILLE, MS 38862-9709
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
0059659
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0059659
SPECIALIST
MS
Enumeration date
07/07/2020
Last updated
07/07/2020
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