Provider Demographics
NPI:1033821004
Name:TATE, SHAKENIA A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHAKENIA
Middle Name:A
Last Name:TATE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 PLEASANT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2544
Mailing Address - Country:US
Mailing Address - Phone:501-269-0853
Mailing Address - Fax:
Practice Address - Street 1:150 E SIEBENMORGEN RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4000
Practice Address - Country:US
Practice Address - Phone:501-329-6851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily