Provider Demographics
NPI:1194155192
Name:BARKSDALE, AMY M (CRNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-642-3005
Mailing Address - Fax:610-642-3057
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-642-3005
Practice Address - Fax:610-642-3057
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013423363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA440771OtherMLHC MEDICARE AA #
PR232359401OtherMLHC TIN