Provider Demographics
NPI:1568168474
Name:ARCHIE, TEMPEST G (PROVIDER)
Entity Type:Individual
Prefix:
First Name:TEMPEST
Middle Name:G
Last Name:ARCHIE
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:TEMPEST
Other - Middle Name:G
Other - Last Name:ARCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2033 FORT CAMPBELL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-4929
Mailing Address - Country:US
Mailing Address - Phone:866-479-7334
Mailing Address - Fax:
Practice Address - Street 1:301 LANDRUM PL APT A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2046
Practice Address - Country:US
Practice Address - Phone:931-539-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)