1710347471 NPI number — MS. AMBER MICHELLE BARKSDALE APRN, CPNP

Table of content: MS. AMBER MICHELLE BARKSDALE APRN, CPNP (NPI 1710347471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710347471 NPI number — MS. AMBER MICHELLE BARKSDALE APRN, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARKSDALE
Provider First Name:
AMBER
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710347471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2647 S SAINT ELIZABETH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GONZALES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70737-5021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-743-2651
Provider Business Mailing Address Fax Number:
225-644-5213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17609 OLD JEFFERSON HWY STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70769-3980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-765-5500
Provider Business Practice Location Address Fax Number:
225-744-2992
Provider Enumeration Date:
02/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  08656 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2413678 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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