Active NPI
Katelyn Patricia Montgomery, PA-C
- Physician Assistant
- Wilmington, DE
National Provider Identifier
1124436621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA056937
- Practice address
- 1600 Rockland Rd
Wilmington, DE 19803-3607 - Phone
- (302) 651-4200
- Fax
- (302) 651-6410
- NPI assigned
- Jul 28, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA056937 | PA | Primary |
| Physician Assistant | 363A00000X | PA031190 | DC |
Addresses
Primary practice location
1600 Rockland Rd
Wilmington, DE 19803-3607
Mailing address
PO Box 191
Rockland, DE 19732-0191
Other practice location 1
1068 W Baltimore Pike
Media, PA 19063-5104
Phone (610) 891-3432
Other practice location 2
255 W Lancaster Ave
Paoli, PA 19301-1763
Phone (484) 565-1000
Other practice location 3
130 S Bryn Mawr Ave
Bryn Mawr, PA 19010-3121
Phone (484) 337-3000
Other practice location 4
100 E Lancaster Ave
Wynnewood, PA 19096-3450
Phone (484) 476-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA031190 | DC | MD | Physician Assistant |
| MA056937 | PA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621814400000",
"number": "1124436621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 191",
"city": "ROCKLAND",
"state": "DE",
"postal_code": "197320191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 ROCKLAND RD",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198033607",
"telephone_number": "302-651-4200",
"fax_number": "302-651-6410"
}
],
"practiceLocations": [
{
"address_1": "1068 W Baltimore Pike",
"address_purpose": "LOCATION",
"city": "Media",
"state": "PA",
"postal_code": "190635104",
"country_code": "US",
"telephone_number": "610-891-3432",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "255 W Lancaster Ave",
"address_purpose": "LOCATION",
"city": "Paoli",
"state": "PA",
"postal_code": "193011763",
"country_code": "US",
"telephone_number": "484-565-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "130 S Bryn Mawr Ave",
"address_purpose": "LOCATION",
"city": "Bryn Mawr",
"state": "PA",
"postal_code": "190103121",
"country_code": "US",
"telephone_number": "484-337-3000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "100 E Lancaster Ave",
"address_purpose": "LOCATION",
"city": "Wynnewood",
"state": "PA",
"postal_code": "190963450",
"country_code": "US",
"telephone_number": "484-476-2000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "KATELYN",
"middle_name": "PATRICIA",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-28",
"last_updated": "2021-05-24",
"certification_date": "2021-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA056937",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "DC",
"license": "PA031190",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.