Provider Demographics
NPI:1609631209
Name:MOLENHOUR, DYLAN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:MOLENHOUR
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4657 S WINSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3215
Mailing Address - Country:US
Mailing Address - Phone:318-754-5754
Mailing Address - Fax:
Practice Address - Street 1:8988 S SHERIDAN RD STE D2
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5035
Practice Address - Country:US
Practice Address - Phone:918-608-0380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK218671363LP0808X
LA211314163WN0002X, 363LP0808X
TX1167659363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care