Provider Demographics
NPI:1679212773
Name:BARKSDALE, MARIA DIANNE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DIANNE
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 1:255 RAY CRAIN RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN MOUND
Mailing Address - State:TN
Mailing Address - Zip Code:37079-5417
Mailing Address - Country:US
Mailing Address - Phone:256-613-9678
Mailing Address - Fax:
Practice Address - Street 1:250 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5186
Practice Address - Country:US
Practice Address - Phone:931-245-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95697164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse