Provider Demographics
NPI:1780105858
Name:ARCHIBALD, VICTORIA KAY (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KAY
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 8TH AVE STE 650
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4160
Mailing Address - Country:US
Mailing Address - Phone:817-912-9180
Mailing Address - Fax:817-912-9190
Practice Address - Street 1:900 W MAGNOLIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8518
Practice Address - Country:US
Practice Address - Phone:817-870-7300
Practice Address - Fax:817-332-5117
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant