Provider Demographics
NPI:1740152115
Name:BARKSDALE, OLIVIA PAIGE (PA-C)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:PAIGE
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 UNION ST STE 145
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3073
Mailing Address - Country:US
Mailing Address - Phone:207-973-9595
Mailing Address - Fax:
Practice Address - Street 1:885 UNION ST STE 145
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3073
Practice Address - Country:US
Practice Address - Phone:207-973-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2953363AM0700X
VA0110011349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant