Individual provider Active NPI

Mary L Montgomery, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Seattle, WA
National Provider Identifier
1790846475
Registry record updated Oct 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP30005664 Issued in WA
Practice address
2329 4TH Ave
Seattle, WA 98121-1717
Phone
(206) 461-3649
Fax
(206) 461-8391
NPI assigned
Dec 13, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP30005664 WA Primary

Addresses

Primary practice location

2329 4TH Ave
Seattle, WA 98121-1717

Mailing address

11000 Lake City Way NE
Community Psychiatric Clinic
Seattle, WA 98125-6748
Phone (206) 461-3614

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)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sound CurrentSince Oct 11, 2023 Accepting new patients

Locations

2329 4th Ave
Seattle, WA 98121
Phone (206) 461-3649

11000 Lake City Way NE
Ste 200
Seattle, WA 98125
Phone (206) 461-3614

11000 Lake City Way NE
Seattle, WA 98125
Phone (206) 461-3614

1600 E Olive St
Seattle, WA 98122
Phone (206) 302-2800

6400 Southcenter Blvd
Tukwila, WA 98188
Phone (206) 444-3600

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.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223164800000",
    "number": "1790846475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11000 LAKE CITY WAY NE",
            "address_2": "COMMUNITY PSYCHIATRIC CLINIC",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981256748",
            "telephone_number": "206-461-3614",
            "fax_number": "206-634-3596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2329 4TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981211717",
            "telephone_number": "206-461-3649",
            "fax_number": "206-461-8391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "MARY",
        "middle_name": "L",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2008-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP30005664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2008; 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.