Provider Demographics
NPI:1982303087
Name:ARCHER, AMY JOLENE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JOLENE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 SW 81ST ST # B7
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-4734
Mailing Address - Country:US
Mailing Address - Phone:405-534-6415
Mailing Address - Fax:
Practice Address - Street 1:2624 SW 81ST ST # B7
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-4734
Practice Address - Country:US
Practice Address - Phone:405-534-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist