Provider Demographics
NPI:1023034543
Name:ARCHER, JENNIFER LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:ARCHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:HAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6582 165TH ST
Mailing Address - Street 2:
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531-8793
Mailing Address - Country:US
Mailing Address - Phone:641-932-7172
Mailing Address - Fax:641-932-7174
Practice Address - Street 1:6582 165TH ST
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531-8793
Practice Address - Country:US
Practice Address - Phone:641-932-7172
Practice Address - Fax:641-932-7174
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105742163W00000X
IAA105742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0728006Medicaid
IA27254OtherWELLMARK BCBS
IA27314OtherWELLMARK BCBS
IA27328OtherWELLMARK BCBS
IA27327OtherWELLMARK BCBS
IA27246OtherWELLMARK BCBS
IAI21398Medicare PIN
IA27314OtherWELLMARK BCBS
Q72836Medicare UPIN