Ebony Monique Montgomery, APRN

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

125407 Issued in AR

Practice address

1410 Braden Street
Jacksonville, AR 72076

Phone

(870) 280-2578

Fax

(844) 447-2520

NPI assigned

Apr 8, 2019

Last updated

Feb 26, 2025By the provider in NPPES

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 AR, WA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ideal Telemedicine Services LLCGroup PAC ID 2860726221, 47 clinicians

Ideal Option PLLCGroup PAC ID 6709013105, 90 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations (25 of 48)

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

• Ideal Option, PLLC

  • Clinic/Center
  • Kennewick, WA
  • NPI 1457788275

  AR

  Medicare reassignment Care Compare group NPD
• Ideal Telemedicine Services, LLC

  • Clinic/Center
  • Renton, WA
  • NPI 1346754868

  AR

  Medicare reassignment Care Compare group NPD
• Wound Care Plus, LLC

  • Specialist
  • Saint Louis, MO
  • NPI 1841657053

  AR

  Medicare reassignment NPD
• Ideal Option, PLLC

  • Clinical Medical Laboratory
  • Renton, WA
  • NPI 1538662663
  NPD
• Ideal Option, PLLC

  • Clinical Medical Laboratory
  • Kennewick, WA
  • NPI 1841648623
  NPD
• Ideal Telemedicine Services, LLC

  • Clinic/Center
  • Rosedale, MD
  • NPI 1427561828
  NPD (past)

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1629531595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SW 7TH ST STEA205",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "98057",
            "telephone_number": "877-522-1275",
            "fax_number": "833-888-7145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 BRADEN STREET",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "72076",
            "telephone_number": "870-280-2578",
            "fax_number": "844-447-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "EBONY",
        "middle_name": "MONIQUE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-08",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AR",
            "license": "125407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Nashel Miller, ADC
• Amanda Patrice Mills, LPC
• Lindsey Mills, LPC
• Daviaunna Mitchell
• Mitchell's Transport
• Vicki Reed Moody-Hall, LPC
• Moore Solutions Inc (On the move physical therapy)
• Moore Solutions, Inc. (On The Move Physical Therapy)
• Calvin Moore-Smith, LPC
• Abby Moore

• Gerontology Nurse Practitioner in Jacksonville, AR
• Providers in Jacksonville, AR by specialty
• Gerontology Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.