Healthcare Provider Details

I. General information

NPI: 1568115756
Provider Name (Legal Business Name): NICOLA C. BARKSDALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 06/18/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RINGGOLD INDUSTRIAL PKWY STE 124
DANVILLE VA
24540-5548
US

IV. Provider business mailing address

300 RINGGOLD INDUSTRIAL PKWY STE 124
DANVILLE VA
24540-5548
US

V. Phone/Fax

Practice location:
  • Phone: 434-483-4351
  • Fax:
Mailing address:
  • Phone: 434-483-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0001228366
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: