Provider Demographics
NPI:1346749504
Name:GATES, KIMBERLY (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:2504 MCCAIN BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7624
Mailing Address - Country:US
Mailing Address - Phone:501-812-6655
Mailing Address - Fax:501-812-6677
Practice Address - Street 1:2504 MCCAIN BLVD STE 118
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7624
Practice Address - Country:US
Practice Address - Phone:501-812-6655
Practice Address - Fax:501-812-6677
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily