Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 52055 | OK |
NPI | 1194090134 |
---|---|
Provider Name | Ms. Vicki R Montgomery |
First Address | Oklahoma City, OK 73112-5556 |
Second Address | Oklahoma City, OK 73112-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2012 |
Last Update Date | 05/02/2016 |