Provider Demographics
NPI:1912446071
Name:HUTCHISON, JACEY CHA' (DO)
Entity Type:Individual
Prefix:MRS
First Name:JACEY
Middle Name:CHA'
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JACEY
Other - Middle Name:CHA'
Other - Last Name:REEDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 720006
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4006
Mailing Address - Country:US
Mailing Address - Phone:405-533-6057
Mailing Address - Fax:
Practice Address - Street 1:717 S HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9023
Practice Address - Country:US
Practice Address - Phone:918-382-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK6423208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program