| Kenneth Archer Md Pa | |
|
1016 Bourland Rd Keller TX 76248-3925 | |
| (817) 691-8711 | |
| Not Available |
| Full Name | Kenneth Archer Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1016 Bourland Rd, Keller, Texas |
| Authorized Official Name and Position | Kenneth Archer (CEO) |
| Authorized Official Contact | 8176918711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth Archer Md Pa Po Box 2077 Keller TX 76244-2077 Ph: () - | Kenneth Archer Md Pa 1016 Bourland Rd Keller TX 76248-3925 Ph: (817) 691-8711 |
| NPI Number | 1700660628 |
|---|---|
| Provider Enumeration Date | 08/22/2023 |
| Last Update Date | 08/22/2023 |
| Medicare PECOS PAC ID | 3678920089 |
|---|---|
| Medicare Enrollment ID | O20231107001709 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700660628 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Kenneth Dean Archer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083654123 PECOS PAC ID: 6800897075 Enrollment ID: I20070131000227 |
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