Provider Demographics
NPI:1437672326
Name:MONTGOMERY, KELSIE (NP-C)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-619-8632
Mailing Address - Fax:435-619-8633
Practice Address - Street 1:2891 E MALL DR STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2399
Practice Address - Country:US
Practice Address - Phone:435-619-8632
Practice Address - Fax:435-619-8633
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7875142-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily