Provider Demographics
NPI:1770443848
Name:TATE, MARY LEE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LEE
Last Name:TATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 FINANCIAL CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3552
Mailing Address - Country:US
Mailing Address - Phone:501-255-7375
Mailing Address - Fax:866-716-1451
Practice Address - Street 1:1825 HIDDEN CREEK DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2286
Practice Address - Country:US
Practice Address - Phone:501-944-5939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL035219164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse