Provider Demographics
NPI:1265837454
Name:BARKSDALE, PATRICIA ANN (LPN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:7249 WOODMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3630
Mailing Address - Country:US
Mailing Address - Phone:313-458-2479
Mailing Address - Fax:
Practice Address - Street 1:7249 WOODMONT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3630
Practice Address - Country:US
Practice Address - Phone:313-458-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703107126164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse