Provider Demographics
NPI:1225141633
Name:ARCHER, KATHLEEN (CNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45887 ROAD FORK RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43788-9736
Mailing Address - Country:US
Mailing Address - Phone:740-838-7005
Mailing Address - Fax:740-838-5273
Practice Address - Street 1:15708 MCCONNELLSVILLE RD
Practice Address - Street 2:IHS
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9678
Practice Address - Country:US
Practice Address - Phone:740-732-5188
Practice Address - Fax:740-732-2874
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner