Provider Demographics
NPI:1710347471
Name:BARKSDALE, AMBER MICHELLE (APRN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:MICHELLE
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 S SAINT ELIZABETH BLVD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5021
Mailing Address - Country:US
Mailing Address - Phone:225-743-2651
Mailing Address - Fax:225-644-5213
Practice Address - Street 1:17609 OLD JEFFERSON HWY STE F
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3980
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-744-2992
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08656363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2413678Medicaid