Provider Demographics
NPI:1497972251
Name:ARCHER, AMY MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2005 STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-8559
Mailing Address - Country:US
Mailing Address - Phone:812-254-4650
Mailing Address - Fax:812-254-4081
Practice Address - Street 1:2005 STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-8559
Practice Address - Country:US
Practice Address - Phone:812-254-4650
Practice Address - Fax:812-254-4081
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6429207Q00000X
IN02-003403A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001039835OtherANTHEM
IN200908640Medicaid
IN258190061Medicare PIN