Jasmin Archie, FNP
Individual provider Active NPI Nurse Practitioner · Westville, IN
NPI 1750112769 · NPPES record last updated Aug 12, 2024
Key facts
- NPI
- 1750112769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 71015548A (IN)
- Practice address
- 5501 S 1100 W
Westville, IN 46391-9335 - Phone
- (219) 785-2511
- Fax
- (317) 232-3992
- NPI assigned
- Aug 12, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4055 Valley View LN
Suite 700
Dallas, TX 75244-4910
4055 Valley View LN
Suite 700
Dallas, TX 75244-5045
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, IN
- 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 |
|---|---|---|---|---|
| I20250916001017 | IL | Practitioner - Nurse Practitioner | 4183128069 | Reassigns benefits to 1 organization |
| I20251001000214 | IN | Practitioner - Nurse Practitioner | 4183128069 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71015548A | IN | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71015548A | IN | Yes |
Addresses
Primary practice location
5501 S 1100 W
Westville, IN 46391-9335
Mailing address
228 W US Highway 30 # 183
Schererville, IN 46375-1854
Phone (219) 680-9399
Other providers in Westville, IN
- Angelic Wellness LLC
- Eduardo Braun
- Barbara Ann Brubaker
- Tracy Ann Coffey
- Erica Nicole Crittendon
- Diane Hunt
All providers in Westville, IN · Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2024. 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.