Provider Demographics
NPI:1881300655
Name:ARCHER, JAMIE LUVINA (NP)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LUVINA
Last Name:ARCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LUVINA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:969 N MASON RD STE 170
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6387
Mailing Address - Country:US
Mailing Address - Phone:314-628-8200
Mailing Address - Fax:314-628-9504
Practice Address - Street 1:969 N MASON RD STE 170
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6387
Practice Address - Country:US
Practice Address - Phone:314-628-8200
Practice Address - Fax:314-628-9504
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOAG10200184363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology