Healthcare Provider Details

I. General information

NPI: 1962746131
Provider Name (Legal Business Name): TARA JEAN BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 05/16/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 E US HIGHWAY 66
EL RENO OK
73036-9125
US

IV. Provider business mailing address

7777 EAST HIGHWAY
EL RENO OK
73036-9116
US

V. Phone/Fax

Practice location:
  • Phone: 405-424-7711
  • Fax:
Mailing address:
  • Phone: 405-425-0452
  • Fax: 580-323-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: