Healthcare Provider Details

I. General information

NPI: 1386368611
Provider Name (Legal Business Name): AARON ARCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7506 OAK RIDGE HWY
KNOXVILLE TN
37931-3333
US

IV. Provider business mailing address

1001 WYNDHAM WAY APT 1212
KNOXVILLE TN
37923-7117
US

V. Phone/Fax

Practice location:
  • Phone: 865-500-6435
  • Fax:
Mailing address:
  • Phone: 865-258-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32438
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: