Provider Demographics
NPI:1245719590
Name:TATE, CARRIE (PMHNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-0414
Mailing Address - Country:US
Mailing Address - Phone:501-679-0232
Mailing Address - Fax:833-373-0348
Practice Address - Street 1:1813 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6086
Practice Address - Country:US
Practice Address - Phone:501-679-0232
Practice Address - Fax:833-373-0348
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005838363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health