Healthcare Provider Details

I. General information

NPI: 1063841666
Provider Name (Legal Business Name): JUDITH OCHIENG FNP-PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N CHURCH AVE
TUCSON AZ
85701-1121
US

IV. Provider business mailing address

177 N CHURCH AVE
TUCSON AZ
85701-1121
US

V. Phone/Fax

Practice location:
  • Phone: 520-210-7008
  • Fax: 520-210-7398
Mailing address:
  • Phone: 520-210-7008
  • Fax: 520-210-7398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberAP5284
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP5284
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: