Basic Information
| Provider Information | |||||||||
| NPI: | 1396363420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GICHIA-WALDROP | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | WANGARI | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DNP, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8 | ||||||||
| Address2: | |||||||||
| City: | SICILY ISLAND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713680008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183895727 | ||||||||
| FaxNumber: | 3183899943 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 WATSON RD | ||||||||
| Address2: | |||||||||
| City: | WISNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713784660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187247008 | ||||||||
| FaxNumber: | 3187247646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2020 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 215790 | TN | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 221690 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 27897 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.