Individual
JULIE LYNETTE TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1110 SE 30TH ST, BENTONVILLE, AR 72712
(479) 282-2966
(479) 282-2967
Mailing address
PO BOX 2760, BENTONVILLE, AR 72712-7704
(314) 620-1719
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
E7529
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192425001
—
AR
Enumeration date
02/15/2008
Last updated
03/08/2022
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