Provider Demographics
NPI:1043639073
Name:BARKSDALE, JOHN
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BARKSDALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:BARKSDALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:736 JONES ST
Mailing Address - Street 2:APT 10
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-6440
Mailing Address - Country:US
Mailing Address - Phone:408-643-9976
Mailing Address - Fax:
Practice Address - Street 1:736 JONES ST
Practice Address - Street 2:APT 10
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6440
Practice Address - Country:US
Practice Address - Phone:408-643-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271491164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse