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NPI Code Detail

MEDICARE: KIMBERLY GATES APRN

MEDICARE: KIMBERLY GATES APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerA005505AR

General Provider Information

NPI Number : 1346749504
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY GATES APRN
Provider Business Mailing Address
First Line : 2504 MCCAIN BLVD STE 118
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72116-7624
Country : US
Telephone Number : 501-812-6655
Fax Number : 501-812-6677
Provider Business Practice Location Address
First Line : 2504 MCCAIN BLVD STE 118
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72116-7624
Country : US
Telephone Number : 501-812-6655
Fax Number : 501-812-6677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2018
Last Update Date : 03/17/2018

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