Provider Demographics
NPI:1194861625
Name:HUTCHENS, CHANCE M
Entity Type:Individual
Prefix:MR
First Name:CHANCE
Middle Name:M
Last Name:HUTCHENS
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 1:825 E ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6610
Mailing Address - Country:US
Mailing Address - Phone:405-364-7900
Mailing Address - Fax:405-366-6214
Practice Address - Street 1:825 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6610
Practice Address - Country:US
Practice Address - Phone:405-364-7900
Practice Address - Fax:405-366-6214
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1582363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200104660AMedicaid
OKPA006362Medicare PIN
OK200104660AMedicaid