Tyler Russell Archer, MSN, NP-C
Individual provider Active NPI Family Nurse Practitioner · Cleveland, TN
NPI 1548770944 · NPPES record last updated May 28, 2020
Key facts
- NPI
- 1548770944
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 23287 (TN)
- Practice address
- 102 Dunhill PL NW
Cleveland, TN 37311 - Phone
- (423) 339-9581
- Fax
- (423) 472-0494
- NPI assigned
- Oct 11, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Interventional Pain Consultants
Practice addresses (Care Compare)
2550 Business Park Dr NE
Cleveland, TN 37311-6503
Phone (423) 339-9581
Hospital & facility affiliations
- Enhabit Home Health
- Adoration Home Health and Hospice Care East TN
- Starr Regional Medical Center Athens
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180205001421 | TN | Practitioner - Nurse Practitioner | 5597025940 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23287 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elite Pain Consultants, PLLC | Current |
Accepting new patients | |
| Interventional Pain Consultants | Current |
Accepting new patients | |
| Interventional Pain Consultants | Current |
Accepting new patients | |
| Mahmood a Siddiqui MD PC | Past | Accepting new patients |
Locations
2550 Business Park Dr NE
Cleveland, TN 37311
Phone (423) 339-8881
102 Dunhill Pl NW
Cleveland, TN 37311
Phone (423) 339-9581
11416 Grigsby Chapel Rd
Ste 104
Knoxville, TN 37934
Phone (865) 218-2100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 23287 | TN | Yes |
Addresses
Primary practice location
102 Dunhill PL NW
Cleveland, TN 37311
Mailing address
102 Dunhill PL NW
Cleveland, TN 37311-3885
Phone (423) 476-5774
Other practice location 1
4021 Keith St NW
Cleveland, TN 37312-4341
Phone (423) 328-1006
Other practice location 2
4021 Keith St NW
Cleveland, TN 37312
Phone (423) 328-1006
Other providers in Cleveland, TN
- Aptitude Behavioral Services, LLC
- Clemente Ocampo Aquino Jr.
- Emmanuel Aragon
- Rebekah Aranda
- Roxana Edith Araujo
- Aria Behavior Analysis, LLC
- Arlington Caregiving
- Lynette Amber Armstrong
- Amanda Arnold
- Melissa Arrendale
All providers in Cleveland, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.