Active NPI
Jolynn Montgomery, PA-C
- Physician Assistant
- Meridian, ID
National Provider Identifier
1730459389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1075
- Practice address
- 2112 E Franklin Rd
Meridian, ID 83642-9024 - Phone
- (800) 769-0045
- NPI assigned
- Jan 12, 2012
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1010 | AK | |
| Physician Assistant | 363A00000X | 60593479 | WA | |
| Physician Assistant | 363A00000X | 673 | HI | |
| Physician Assistant | 363A00000X | 1075 | ID | Primary |
Addresses
Primary practice location
2112 E Franklin Rd
Meridian, ID 83642-9024
Mailing address
2112 E Franklin Rd
Meridian, ID 83642-9024
Phone (800) 769-0045
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 |
|---|---|---|---|
| 1010 | AK | MD | Dental Hygienist |
| 1075 | ID | MD | Physician Assistant |
| 60593479 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Planned Parenthood Great Northwest, Hawai'I, Alaska, Indiana, Kentucky | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Non-Surgical Family Planning Clinic/Center
- Honolulu, HI
- NPI 1558424473
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702339200000",
"number": "1730459389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2112 E FRANKLIN RD",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836429024",
"telephone_number": "800-769-0045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2112 E FRANKLIN RD",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836429024",
"telephone_number": "800-769-0045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "JOLYNN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-12",
"last_updated": "2023-12-12",
"certification_date": "2023-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AK",
"license": "1010",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "60593479",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "HI",
"license": "673",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "1075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.