Healthcare Provider Details

I. General information

NPI: 1982179446
Provider Name (Legal Business Name): MARC DAVID ARCHER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13655 RIVERPORT DR
MARYLAND HEIGHTS MO
63043-4812
US

IV. Provider business mailing address

13655 RIVERPORT DR
MARYLAND HEIGHTS MO
63043-4812
US

V. Phone/Fax

Practice location:
  • Phone: 816-947-0327
  • Fax: 844-357-5351
Mailing address:
  • Phone: 816-947-0327
  • Fax: 844-357-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018035121
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: