Individual
AUTUMN KATHRYN MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
451 S AMELIA AVE, DELAND, FL 32724-5917
(317) 670-6794
(386) 734-8614
Mailing address
451 S AMELIA AVE, DELAND, FL 32724-5917
(317) 670-6794
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11002221
FL
363LF0000X
Family Nurse Practitioner
Primary
71008480A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11002221
FLORIDA APRN LICENSE
FL
01
—
71008480A
APRN PRESCRIPTIVE AUTHORITY
IN
Enumeration date
08/31/2018
Last updated
04/08/2026
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