MRS. EBONY MONIQUE MONTGOMERY (APRN) – Gerontology Nurse Practitioner, NPI 1629531595
Gerontology Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,074 NURSE PRACTITIONER in LA
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Provider Addresses for MRS. EBONY MONIQUE MONTGOMERY (APRN)
12216 AMARANTH DR
NORTH LITTLE ROCK, AR 721179753
Phone: (501) 319-3256
Type: Mailing
Bluebonnet Boulevard, Park Plaza, Baton Rouge, East Baton Rouge Parish, Louisiana, 70809-2591, United States
BATON ROUGE, LA 708102973
Phone: (870) 280-2578
Fax: (844) 447-2520
Type: Location
1410 BRADEN STREET
JACKSONVILLE, AR 72076
Phone: (870) 280-2578
Fax: (844) 447-2520
Type: Location
500 SW 7TH ST STEA205
RENTON, WA 98057
Phone: (877) 522-1275
Fax: (833) 888-7145
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-04-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20201218001118 | I | Nurse Practitioner | AR | TBD |
| I20250409002573 | I | Nurse Practitioner | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 72117)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Hospitalist, Internal Medicine | WA | |
| Physician Assistant | TX | |
| - | MD | |
| - | CA | |
| - | WA | |
| Physician Assistant | WA | |
| - | MN | |
| Nurse Practitioner | MD | |
| Physician Assistant | WA | |
| Physician Assistant | MD |
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