MRS. IDA SUE MONTGOMERY (NPI# 1104809359) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104809359 |
Entity Type | Individual |
Full Name | MRS. IDA SUE MONTGOMERY |
Credential | CRNP |
Practice Address |
301 Andrews Avenue Lyster Army Outpatient Clinic Fort Rucker AL 36362 |
Practice Telephone | 3342557387 |
Mailing Telephone | 3342557387 |
Enumeration Date | 2005-11-22 |
Last Update Date | 2007-07-08 |
Gender Code | F |
Is Sole Proprietor | X |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
APRN-384 | HI | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
301 ANDREWS AVENUE LYSTER ARMY OUTPATIENT CLINIC |
City | FORT RUCKER |
State | AL |
Zip Code | 36362 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932107307 | James C. Dover | Optometrist | 301 Andrews Avenue, Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2005-07-11 |
1598376469 | Wesley Hendrick Mccormick | Psychologist | 301 Andrews Avenue, Fort Rucker, AL 36362 | 2020-08-13 |
1366936817 | Twanna Versel Johnson | Social Worker | 301 Andrews Avenue, Cavhcs (va Wiregrass Clinic), Fort Rucker, AL 36362 | 2018-06-19 |
1770096406 | Jose A Morejon | Emergency Medical Technician, Basic | 301 Andrews Avenue, Fort Rucker, AL 36362 | 2017-11-16 |
1013446723 | Christopher Warren Fleming | Pharmacist | 301 Andrews Avenue, Fort Rucker, AL 36362 | 2017-06-06 |
1497296701 | Cody Shedd | Emergency Medical Technician, Basic | 301 Andrews Avenue, Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2017-03-20 |
1760924583 | James Darren Beasley | Physical Therapy Assistant | 301 Andrews Avenue, Fort Rucker, AL 36360 | 2016-11-10 |
1538616768 | Deseree Moe | Emergency Medical Technician, Basic | 301 Andrews Avenue, Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2016-09-06 |
1093261232 | Kristin Henderson | Registered Nurse | 301 Andrews Avenue, Fort Rucker, AL 36362 | 2016-08-28 |
1942652490 | Evie Ehret | Occupational Therapist | 301 Andrews Avenue, Fort Rucker, AL 36362 | 2016-07-08 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235745571 | Rachel Kestler | Specialist | 4102 Gadiator Street, Fort Rucker, AL 36362 | 2020-09-22 |
1417589268 | Jacob Michael Lezon | Emergency Medical Technician, Basic | 30501 Nevins St., Ft. Rucker, AL 36362 | 2020-02-10 |
1225535388 | Rhonda Lewis Wesolek | Dental Hygienist | Bldg 4405, Innkeeper Street, Fort Rucker, AL 36362 | 2018-04-06 |
1770013369 | National Vision, Inc. | Technician/Technologist | Bldg 9214, Fort Rucker, AL 36362 | 2017-06-15 |
1750730958 | Teresa Morgan Knighten | Dental Hygienist | 4405 Innkeepers St, Fort Rucker, AL 36362 | 2016-06-08 |
1568826246 | David Virgil II | Technician, Other | 2218 6th Avenue Building 4102, Fort Rucker, AL 36362 | 2016-04-08 |
1356771257 | Robert E Smith | Emergency Medical Technician, Intermediate | Blding 301 Andrew Ave, Ft Rucker, AL 36362 | 2013-11-14 |
1548503469 | Lindsey Taylor Mendenhall | Emergency Medical Technician, Basic | Bldg 301 Andrews Ave 1-223rd Hhc, Lyster Army Health Clinic, Fort Rucker, AL 36362 | 2013-03-28 |
1689913808 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | Fort Rucker Bldg. 9214, Daleville, AL 36362 | 2013-02-07 |
1275880205 | Sandra Lynn Griffin Banner | Optometrist | 33 Endl Ave, Fort Rucker, AL 36362 | 2012-08-09 |
Find all providers in zip 36362 |
Taxonomy Code | 363LP2300X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Primary Care |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1396726733 | Annie Stevens Boothe | Nurse Practitioner | 301 Andrews Avenue, Fort Rucker, AL 36362 | 2005-11-11 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437765872 | Tracie Diane Lavinsky | Nurse Practitioner | 13025 Alla Dr, Coker, AL 35452-3780 | 2020-09-21 |
1861007957 | Kerri Lane Griffin | Nurse Practitioner | 1275 James Dr Ste A, Enterprise, AL 36330-2484 | 2020-09-15 |
1457971079 | Lindsay Morris | Nurse Practitioner | 122 7th Ave Ne Ste D, Alabaster, AL 35007-9121 | 2020-04-23 |
1508492505 | Tiffany Michele Folse | Nurse Practitioner | 9618 Chariot Ave, Fairhope, AL 36532-7412 | 2020-03-21 |
1548809239 | Isuan Iriabho | Nurse Practitioner | Russell Medical Center, 3316 Us-280, Alexander City, AL 35010-9114 | 2019-12-30 |
1104476423 | Anaidra L Reese | Nurse Practitioner | 2079 S Evergreen Dr, Auburn, AL 36830-6942 | 2019-09-18 |
1104481944 | Deanna Montieth | Nurse Practitioner | 718 Downtowner Loop W, Mobile, AL 36609-5504 | 2019-05-07 |
1538622055 | Dana Marie Register | Nurse Practitioner | 11119 S County Road 49, Slocomb, AL 36375-5871 | 2019-04-11 |
1396218707 | Christine Wood | Nurse Practitioner | 4704 Whitesburg Dr Sw Ste 100, Huntsville, AL 35802-4302 | 2019-01-08 |
1780151514 | Mary Virginia Halbrooks | Nurse Practitioner | 1001 Hill St Sw, Hartselle, AL 35640-2801 | 2018-10-30 |
Find all providers with the same taxonomy |
City | FORT RUCKER |
Zip Code | 36362 |
Please comment or provide details below to improve the information on MRS. IDA SUE MONTGOMERY.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.