Provider Demographics
NPI:1548414931
Name:WHEAT-HITCHINGS, LACREASIA K (MD)
Entity Type:Individual
Prefix:DR
First Name:LACREASIA
Middle Name:K
Last Name:WHEAT-HITCHINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LACREASIA
Other - Middle Name:KORSHANNA
Other - Last Name:WHEAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-782-3400
Mailing Address - Fax:360-782-3345
Practice Address - Street 1:9621 RIDGETOP BLVD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8502
Practice Address - Country:US
Practice Address - Phone:360-782-3400
Practice Address - Fax:360-782-3345
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA435712083X0100X
WAMD613879432083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2248320Medicaid
PA214650YJSMedicare PIN