Individual provider Active NPI

Lark Montgomery, APRN

  • Acute Care Nurse Practitioner
  • Jonesboro, AR
National Provider Identifier
1922453935
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
A004702 Issued in AR
Practice address
300 Carson St
Jonesboro, AR 72401-3104
Phone
(870) 932-1198
NPI assigned
Apr 27, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X A004702 AR Primary

Addresses

Primary practice location

300 Carson St
Jonesboro, AR 72401-3104

Mailing address

300 Carson St
Jonesboro, AR 72401-3104

Other practice location 1

225 E Jackson Ave
Jonesboro, AR 72401-3119
Phone (870) 207-4100

Other practice location 2

201 E Oak Ave
Jonesboro, AR 72401-4163
Phone (870) 935-6729

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20160819000532 AR Practitioner - Nurse Practitioner 2769777457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Bernards Physician Clinics IncGroup PAC ID 7012311269, 211 clinicians

Practice addresses (Care Compare)

300 Carson St
Jonesboro, AR 72401-3104
Phone (870) 932-1198

Hospital & facility affiliations

  • St Bernards Medical Center Hospital, Jonesboro, AR, CCN 040020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Bernards Physician Clinics Inc CurrentSince Jan 1, 2023 Accepting new patients
St Bernards Physician Clinics Inc CurrentSince Jan 1, 2023 Accepting new patients

Locations

1005 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 935-1242

201 E Oak Ave
Jonesboro, AR 72401

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1922453935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104",
            "telephone_number": "870-932-1198"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 E Jackson Ave",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724013119",
            "country_code": "US",
            "telephone_number": "870-207-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 E Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724014163",
            "country_code": "US",
            "telephone_number": "870-935-6729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "LARK",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-27",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AR",
            "license": "A004702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.