Healthcare Provider Details

I. General information

NPI: 1225141633
Provider Name (Legal Business Name): KATHLEEN ARCHER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15708 MCCONNELLSVILLE RD IHS
CALDWELL OH
43724-9678
US

IV. Provider business mailing address

45887 ROAD FORK RD
SUMMERFIELD OH
43788-9736
US

V. Phone/Fax

Practice location:
  • Phone: 740-732-5188
  • Fax: 740-732-2874
Mailing address:
  • Phone: 740-838-7005
  • Fax: 740-838-5273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP06116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: