Tiffany Ann Montgomery, CHW

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

112313 Issued in OR

Practice address

2011 4TH St
La Grande, OR 97850-2511

Phone

(541) 963-4139

Fax

(541) 429-6612

NPI assigned

Nov 19, 2024

Last updated

Nov 19, 2024By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1891510335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978502511",
            "telephone_number": "541-963-4139",
            "fax_number": "541-429-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978502511",
            "telephone_number": "541-963-4139",
            "fax_number": "541-429-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "TIFFANY",
        "middle_name": "ANN",
        "credential": "CHW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-19",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OR",
            "license": "112313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim A. Miller
• Susan Eileen Miller, OTR/L
• Thomas Darrell Miller, DC
• Kirsten Marie Mills
• Tristin Mock, ND
• Craig Allen Moore, LMT
• Jennifer A Moore, LAC
• Zola Morris
• William Edward Mosiman, M.D.
• Sammie Lynne Mosley, MS

• Community Health Worker in La Grande, OR
• Providers in La Grande, OR by specialty
• Community Health Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.