Provider Demographics
NPI:1366782104
Name:MONTGOMERY, N. CATHERINE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:N.
Middle Name:CATHERINE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 BROOKHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4203
Mailing Address - Country:US
Mailing Address - Phone:405-354-7815
Mailing Address - Fax:
Practice Address - Street 1:907 BROOKHURST BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4203
Practice Address - Country:US
Practice Address - Phone:405-642-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK792133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered