Basic Information
| Provider Information | |||||||||
| NPI: | 1699755314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTGOMERY | ||||||||
| FirstName: | SONYA | ||||||||
| MiddleName: | MINTES | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSN FNP CS PMHCNS-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158 ZILLICOA ST | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288011079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282549494 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 158 ZILLICOA ST | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288011079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282549494 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 06/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 201440035826122 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 017226502 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | 201440 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1054617 | 01 | NC | CIGNA | OTHER | 60093 | 01 | NC | BCBS | OTHER | 09436000 | 01 | NC | MEGALLAN | OTHER | 6113035 | 05 | NC | MEDICAID |