Individual
CYNTHIA R TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
9500 KANIS RD, HICKINGBOTHAM OUTPATIENT CENTER, LITTLE ROCK, AR 72205-6324
(501) 202-1902
(501) 202-1512
Mailing address
11001 EXECUTIVE CENTER DR, SUITE 200, LITTLE ROCK, AR 72211-4316
(501) 202-1902
(501) 202-1512
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A01369
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152484758
—
AR
01
—
4235835
CIGNA
—
01
—
5U644
BCBS
—
01
—
655627
HEALTHLINK
—
01
—
71-0781138
MULTIPLAN
—
01
—
71-0781138028
TRICARE
—
Enumeration date
07/28/2006
Last updated
02/13/2025
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