Jacy D Donnelly, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

7721 Issued in OK

Practice address

512 W Atlanta St
Broken Arrow, OK 74012-7004

Phone

(918) 370-4461

Fax

(918) 512-4723

NPI assigned

Mar 22, 2021

Last updated

Jul 4, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Parkside, Inc.Group PAC ID 5496644049, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Parkside, Inc.

  • Adult Mental Health Clinic/Center
  • Tulsa, OK
  • NPI 1356552111
  Medicare reassignment Care Compare group NPD
• Parkside, Inc.

  • Psychiatric Hospital
  • Tulsa, OK
  • NPI 1134750649
  NPD
• Robert Hogg DO PLLC

  • Psychiatry Physician
  • Broken Arrow, OK
  • NPI 1851012827
  NPD
• Parkside, Inc.

  • Psychiatric Hospital Unit
  • Tulsa, OK
  • NPI 1346461688
  NPD (past)
• Parkside, Inc.

  • Psychiatric Hospital
  • Tulsa, OK
  • NPI 1437370772
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751587200000",
    "number": "1457937138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 E 31ST ST STE LL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741355018",
            "telephone_number": "918-236-4000",
            "fax_number": "918-236-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 W ATLANTA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127004",
            "telephone_number": "918-370-4461",
            "fax_number": "918-512-4723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "JACY",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-22",
        "last_updated": "2025-07-04",
        "certification_date": "2025-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "7721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawnna Doan, PHARMACIST
• Annabelle Dodson, RBT
• Jennifer Nicole Dodson, CF-SLP
• Myrna Byers Domoney, D.D.S.
• Francis Wayne Donia, CWIC
• Baylee Dosh, CFY
• Carrie Janice Downing
• Dr Brandon Bailey DO PLLC
• Dr Brianna Teel Rehab Services LLC
• Dr King Optometrist PLLC

• Psychiatry Physician in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Psychiatry Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.