Provider Demographics
NPI:1982743449
Name:BARKSDALE, CONSTANCE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:
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 1:33 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-1515
Mailing Address - Country:US
Mailing Address - Phone:781-690-6289
Mailing Address - Fax:
Practice Address - Street 1:150 YORK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1829
Practice Address - Country:US
Practice Address - Phone:781-344-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2074363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical