Individual
TYLER LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 NE 13TH ST, OKLAHOMA CITY, OK 73117-1039
(572) 244-0059
(572) 244-9830
Mailing address
1100 NE 13TH ST, OKLAHOMA CITY, OK 73117-1039
(572) 244-0059
(572) 244-9830
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
41430
OK
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
41430
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2020
Last updated
08/03/2026
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