Healthcare Provider Details

I. General information

NPI: 1346749504
Provider Name (Legal Business Name): KIMBERLY GATES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM GATES APRN

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 MCCAIN BLVD STE 118
NORTH LITTLE ROCK AR
72116-7624
US

IV. Provider business mailing address

2504 MCCAIN BLVD STE 118
NORTH LITTLE ROCK AR
72116-7624
US

V. Phone/Fax

Practice location:
  • Phone: 501-812-6655
  • Fax: 501-812-6677
Mailing address:
  • Phone: 501-812-6655
  • Fax: 501-812-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA005505
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005505
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: