=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609350271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY ARCHER NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2018
-----------------------------------------------------
Last Update Date | 03/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7227 E BASELINE RD STE 126
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85209-5006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-868-9650
-----------------------------------------------------
Fax | 480-834-3606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38734 N JOANN WAY
-----------------------------------------------------
City | SAN TAN VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85140-4024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-334-4763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | AP11747
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------