Healthcare Provider Details

I. General information

NPI: 1740152115
Provider Name (Legal Business Name): OLIVIA PAIGE BARKSDALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 10/24/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 UNION ST STE 145
BANGOR ME
04401-3073
US

IV. Provider business mailing address

885 UNION ST STE 145
BANGOR ME
04401-3073
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-9595
  • Fax:
Mailing address:
  • Phone: 207-973-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011349
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2953
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: