Healthcare Provider Details

I. General information

NPI: 1275547978
Provider Name (Legal Business Name): CYNTHIA R TATE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/13/2025
Certification Date:
Deactivation Date: 01/16/2025
Reactivation Date: 02/13/2025

III. Provider practice location address

9500 KANIS RD HICKINGBOTHAM OUTPATIENT CENTER
LITTLE ROCK AR
72205-6324
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR SUITE 200
LITTLE ROCK AR
72211-4316
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-1902
  • Fax: 501-202-1512
Mailing address:
  • Phone: 501-202-1902
  • Fax: 501-202-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01369
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: