Provider Demographics
NPI:1124495080
Name:MONTGOMERY, DEENA (FNP-C)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2478
Mailing Address - Country:US
Mailing Address - Phone:615-692-2998
Mailing Address - Fax:
Practice Address - Street 1:820 N MOUNT JULIET RD STE 105
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4186
Practice Address - Country:US
Practice Address - Phone:615-601-8949
Practice Address - Fax:615-601-8948
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily