Provider Demographics
NPI:1699336586
Name:GATES, ALICIA MARIE (DNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:GATES
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-9566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:870-856-2133
Practice Address - Street 1:16723 HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:AR
Practice Address - Zip Code:72732-7007
Practice Address - Country:US
Practice Address - Phone:479-359-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily