Provider Demographics
NPI:1679141303
Name:BARRY, KAYLA (PA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:TERREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:405-666-9860
Mailing Address - Fax:405-666-9876
Practice Address - Street 1:750 SW 19TH ST STE A
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2974
Practice Address - Country:US
Practice Address - Phone:405-666-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant