Individual
JO LEAH MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNFA
Contact information
Practice address
3108 MIDWAY RD, STE 104, PLANO, TX 75093-6383
(214) 781-1777
Mailing address
PO BOX 660046, DALLAS, TX 75266-0046
(214) 369-8555
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
623984
TX
163WR0006X
Registered Nurse First Assistant
Primary
623984
TX
163WX0800X
Orthopedic Registered Nurse
623984
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N8090
BCBS
TX
Enumeration date
04/09/2007
Last updated
10/19/2007
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