Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Carolyn A Montgomery, PA-C

Individual provider Physician Assistant · NPI 1588769913

Carolyn A Montgomery, PA-C is a Physician Assistant in Maple Grove, Minnesota. Qualified in 2004, 22 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Indiana and Minnesota.

Years since qualifying
22
Licensed in
IN, MN
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

9555 Upland Ln N
Maple Grove, MN 55369-4485
Phone: (952) 993-1440
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 13212 (MN)
Physician Assistant Taxonomy 363A00000X · Licence 10000785A (IN)

Record details

NPI number1588769913
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 13, 2006
Last updated in NPPESFebruary 11, 2020
Certification dateFebruary 11, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations6 on file with Medicare

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