Healthcare Provider Details

I. General information

NPI: 1801212683
Provider Name (Legal Business Name): CHARISSE BARKSDALE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COMMONWEALTH PL
VIRGINIA BEACH VA
23464-4517
US

IV. Provider business mailing address

900 COMMONWEALTH PL
VIRGINIA BEACH VA
23464-4517
US

V. Phone/Fax

Practice location:
  • Phone: 757-575-6186
  • Fax:
Mailing address:
  • Phone: 757-575-6186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: