Healthcare Provider Details

I. General information

NPI: 1538086160
Provider Name (Legal Business Name): KIMBERLY ADINE ARCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W 10TH ST
SHAWNEE OK
74801-6801
US

IV. Provider business mailing address

1620 N MARKET AVE
SHAWNEE OK
74804-4416
US

V. Phone/Fax

Practice location:
  • Phone: 405-275-2222
  • Fax: 405-275-7740
Mailing address:
  • Phone: 405-923-2284
  • Fax: 405-275-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: