Provider Demographics
NPI:1881173037
Name:MONTOYA, JORDAN (FNP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 SW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-8324
Mailing Address - Country:US
Mailing Address - Phone:806-663-3527
Mailing Address - Fax:
Practice Address - Street 1:7501 FANNIN ST STE 705
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1958
Practice Address - Country:US
Practice Address - Phone:713-589-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138132363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care