Provider Demographics
NPI:1376386318
Name:ARCHER, MCKENSIE STELLA (FNP-C)
Entity type:Individual
Prefix:
First Name:MCKENSIE
Middle Name:STELLA
Last Name:ARCHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 E COAST HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2548
Mailing Address - Country:US
Mailing Address - Phone:949-432-5863
Mailing Address - Fax:
Practice Address - Street 1:3800 E COAST HWY STE 2
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2548
Practice Address - Country:US
Practice Address - Phone:949-432-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030170363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care