MEDICARE: CARLY ARCHER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	27361	TN

General Provider Information

NPI Number	:	1811652241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY ARCHER NP

Provider Business Mailing Address
First Line	:	500 CAHABA PARK CIR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5087
Country	:	US
Telephone Number	:	205-847-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2540
Country	:	US
Telephone Number	:	901-457-0541
Fax Number	:	901-457-0542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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