Provider Demographics
NPI:1255187142
Name:BARKSDALE, ANDRE E SR
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:E
Last Name:BARKSDALE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 AIRPORT DR STE 150
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2297
Mailing Address - Country:US
Mailing Address - Phone:614-407-9040
Mailing Address - Fax:
Practice Address - Street 1:2740 AIRPORT DR STE 150
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2297
Practice Address - Country:US
Practice Address - Phone:614-407-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator