Healthcare Provider Details

I. General information

NPI: 1023906054
Provider Name (Legal Business Name): TONJANIKA R. WEBSTER DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 GAUSE BLVD STE 304
SLIDELL LA
70458-2007
US

IV. Provider business mailing address

636 GAUSE BLVD. STE 304 PMB 1061
SLIDELL LA
70458-2007
US

V. Phone/Fax

Practice location:
  • Phone: 504-313-5002
  • Fax:
Mailing address:
  • Phone: 504-313-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number247198
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: