Organization
LIVING TREE PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE LYNETTE TATE M.D. (CO-OWNER)
(479) 282-2966
Entity
Organization
Contact information
Practice address
1110 SE 30TH STREET, BENTONVILLE, AR 72712-4290
(479) 282-2966
(479) 282-2967
Mailing address
P.O. BOX 2760, BENTONVILLE, AR 72712-4290
(479) 282-2966
(479) 282-2967
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
E7529
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191183001
—
AR
05
—
192425001
—
AR
Enumeration date
01/18/2016
Last updated
03/21/2022
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