Healthcare Provider Details

I. General information

NPI: 1306405741
Provider Name (Legal Business Name): DYLAN MICHAELA KELLY BARNES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 E 91ST ST STE 200
TULSA OK
74137-2806
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3361
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-4788
  • Fax: 918-794-4789
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number100448
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number46026
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: