Provider Demographics
NPI:1730208083
Name:MONTGOMERY, JUANDRIA NICOLE (FNP-C)
Entity type:Individual
Prefix:DR
First Name:JUANDRIA
Middle Name:NICOLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6447 SATJANON DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7241
Mailing Address - Country:US
Mailing Address - Phone:423-443-1145
Mailing Address - Fax:
Practice Address - Street 1:6025 STAGE RD STE 42-346
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-8374
Practice Address - Country:US
Practice Address - Phone:901-443-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3404511171400000X
TN17626363LF0000X
GA274081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6011441OtherBLUE CROSS AND BLUE SHIELD
TNQ001302Medicaid
TNQ001302Medicaid