Provider Demographics
NPI:1639279193
Name:ARCHER, CATHERINE MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4848
Mailing Address - Country:US
Mailing Address - Phone:423-863-9263
Mailing Address - Fax:
Practice Address - Street 1:143 BRITTANY DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-4848
Practice Address - Country:US
Practice Address - Phone:423-477-0674
Practice Address - Fax:423-477-0674
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9782367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered