Chandra L Montgomery, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

636019 Issued in TX

Practice address

1174 Idlewood Dr
Waco, TX 76705-5238

Phone

(254) 214-2558

Fax

(254) 582-5518

NPI assigned

Dec 5, 2006

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Providence Health Alliance

  • Specialist
  • Waco, TX
  • NPI 1932210838
  Medicare reassignment NPD
• Swan Health & Wellness LLC

  • In Home Supportive Care Agency
  • Waco, TX
  • NPI 1508514084
  NPD Authorized official
• Certified Nurse Practitioners, PC

  • Family Nurse Practitioner
  • Austin, TX
  • NPI 1194901413
  Medicare reassignment
• Providence Health Alliance

  • Rural Health Clinic/Center
  • Waco, TX
  • NPI 1336590462
  NPD
• C & K Nurse Practitioner Services, PC

  • Family Medicine Physician
  • Marlin, TX
  • NPI 1598707929
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592179200000",
    "number": "1124186507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1174 IDLEWOOD DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767055238",
            "telephone_number": "254-214-2558",
            "fax_number": "254-582-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1174 IDLEWOOD DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767055238",
            "telephone_number": "254-214-2558",
            "fax_number": "254-582-5518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1302 E Elm St",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "TX",
            "postal_code": "76645",
            "country_code": "US",
            "telephone_number": "254-214-2558",
            "fax_number": "254-582-5518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "CHANDRA",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "636019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelenette Monroe
• Todd Christina Monsen, PT, DPT
• Lisa D Monsisvais, M.S., CCC-SLP
• Mark Damon Montelongo, NP
• Ashley Montemayor
• Holly S Montgomery, OTR
• Katherine M. Moodie, RD, LD
• Devon Nicole Moore, LCSW
• Dianne Downing Moore, SLP
• Dod David Moore, D.D.S.

• Adult Health Nurse Practitioner in Waco, TX
• Providers in Waco, TX by specialty
• Adult Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.