Ida Sue Montgomery, CRNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

APRN-384 Issued in HI

Practice address

301 Andrews Avenue
Lyster Army Outpatient Clinic
Fort Rucker, AL 36362

Phone

(334) 255-7387

NPI assigned

Nov 22, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104809359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 ANDREWS AVENUE",
            "address_2": "LYSTER ARMY OUTPATIENT CLINIC",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "36362",
            "telephone_number": "334-255-7387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 ANDREWS AVENUE",
            "address_2": "LYSTER ARMY OUTPATIENT CLINIC",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "36362",
            "telephone_number": "334-255-7387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "IDA",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-22",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "HI",
            "license": "APRN-384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deseree Moe, NREMT-B
• Feroze John Mohammad, P.A.-C
• Jeffrey Mohr, PTA
• Amber Monske, NREMT-B
• Montgomery Vamc
• Johnnie Moore, LPN
• Melissa Lindsey Moore, RN-BSN
• Shandrea Moore, NREMT
• Gregory Morando, D.M.D
• Jose A Morejon

• Primary Care Nurse Practitioner in Fort Rucker, AL
• Providers in Fort Rucker, AL by specialty
• Primary Care Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.