Provider Demographics
NPI:1730412636
Name:MONTREUIL, JEAN-PAUL (PA)
Entity type:Individual
Prefix:MR
First Name:JEAN-PAUL
Middle Name:
Last Name:MONTREUIL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7149 BLACKSHEEP RUN RD
Mailing Address - Street 2:TMC-5, AVIATION CLINIC
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223
Mailing Address - Country:US
Mailing Address - Phone:270-412-8688
Mailing Address - Fax:270-412-8421
Practice Address - Street 1:1101 GRADE LN BLDG 900
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2673
Practice Address - Country:US
Practice Address - Phone:502-299-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
KYPA2329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant