Provider Demographics
NPI:1114814340
Name:BARKHADLE, NASIR
Entity type:Individual
Prefix:
First Name:NASIR
Middle Name:
Last Name:BARKHADLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E HENNEPIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2700
Mailing Address - Country:US
Mailing Address - Phone:612-759-4807
Mailing Address - Fax:
Practice Address - Street 1:11278 TYLER ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-5504
Practice Address - Country:US
Practice Address - Phone:612-759-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health