Provider Demographics
NPI:1598052201
Name:ARCHILLES, PATRICIA L (CPNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:ARCHILLES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:2716 TIBBETS DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6915
Practice Address - Country:US
Practice Address - Phone:817-571-6644
Practice Address - Fax:817-685-7951
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248897363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285838302OtherCSHCN
TX285838303Medicaid
TX285838303Medicaid