Provider Demographics
NPI:1881925154
Name:MONTGOMERY, KERI (NP)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:CREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 WOODLAND ROAD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ST. HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574
Mailing Address - Country:US
Mailing Address - Phone:707-963-7200
Mailing Address - Fax:707-963-7203
Practice Address - Street 1:6 WOODLAND ROAD
Practice Address - Street 2:SUITE 304
Practice Address - City:ST. HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574
Practice Address - Country:US
Practice Address - Phone:707-963-7200
Practice Address - Fax:707-963-7203
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC203144363LF0000X
COC-APN.0000068-C-NP363LF0000X
COAPN.0991663-NP363LF0000X
CA95012403363LF0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005510Medicaid
NC7005510Medicaid