Provider Demographics
NPI:1548770944
Name:ARCHER, TYLER RUSSELL (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:RUSSELL
Last Name:ARCHER
Suffix:
Gender:M
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 DUNHILL PL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3885
Mailing Address - Country:US
Mailing Address - Phone:423-476-5774
Mailing Address - Fax:423-472-0493
Practice Address - Street 1:102 DUNHILL PL NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-339-9581
Practice Address - Fax:423-472-0494
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily