Healthcare Provider Details

I. General information

NPI: 1639279193
Provider Name (Legal Business Name): CATHERINE MARIE ARCHER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 BRITTANY DR
GRAY TN
37615-4848
US

IV. Provider business mailing address

143 BRITTANY DR
JOHNSON CITY TN
37615-4848
US

V. Phone/Fax

Practice location:
  • Phone: 423-477-0674
  • Fax: 423-477-0674
Mailing address:
  • Phone: 423-863-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9782
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: