Provider Demographics
NPI:1639756174
Name:BARKSDALE, KATRINA LATRICE
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LATRICE
Last Name:BARKSDALE
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 1:2520 10TH ST NE APT 39
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1752
Mailing Address - Country:US
Mailing Address - Phone:202-664-2254
Mailing Address - Fax:
Practice Address - Street 1:3782 HAYES ST NE APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1742
Practice Address - Country:US
Practice Address - Phone:202-873-3957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant