Individual provider Active NPI

Gabriel Reed Archer, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Salem, VA
National Provider Identifier
1245950153
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
0024195582 Issued in VA
Practice address
115 Roanoke Blvd # 5004
Salem, VA 24153-4907
Phone
(865) 234-2562
Fax
(833) 605-4359
NPI assigned
Aug 31, 2022
Last updated
Jan 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0024195582 VA Primary

Addresses

Primary practice location

115 Roanoke Blvd # 5004
Salem, VA 24153-4907

Mailing address

115 Roanoke Blvd # 5004
Salem, VA 24153-4907
Phone (865) 234-2562

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221108002696 TN Practitioner - Nurse Practitioner 3779959556 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0024195582VAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health of East Tennessee, Inc CurrentSince Aug 29, 2022 Accepting new patients

Locations

130 Independence Ln
La Follette, TN 37766
Phone (423) 562-1705

130 Independence Ln
Fl 2
La Follette, TN 37766

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1245950153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 ROANOKE BLVD # 5004",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241534907",
            "telephone_number": "865-234-2562",
            "fax_number": "833-605-4359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ROANOKE BLVD # 5004",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241534907",
            "telephone_number": "865-234-2562",
            "fax_number": "833-605-4359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHER",
        "first_name": "GABRIEL",
        "middle_name": "REED",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-31",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024195582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, VA

Sources for this page

Verify at the official NPI Registry.