Provider Demographics
NPI:1053885012
Name:MONTGOMERY, ERICA SHERE' (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:SHERE'
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:SHERE'
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:256 HONEYSUCKLE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1168
Mailing Address - Country:US
Mailing Address - Phone:334-350-5648
Mailing Address - Fax:334-640-2008
Practice Address - Street 1:256 HONEYSUCKLE RD STE 3
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1168
Practice Address - Country:US
Practice Address - Phone:334-350-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-13
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136193163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health