Healthcare Provider Details

I. General information

NPI: 1760003545
Provider Name (Legal Business Name): TYLER LACKEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TYLER WHITNEY MD

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NE 13TH ST
OKLAHOMA CITY OK
73117-1039
US

IV. Provider business mailing address

1100 NE 13TH ST
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 572-244-0059
  • Fax: 572-244-9830
Mailing address:
  • Phone: 572-244-0059
  • Fax: 572-244-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number41430
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: