MEDICARE: JUDY K WAGGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	M0137471	OK

General Provider Information

NPI Number	:	1720605595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY K WAGGA

Provider Business Mailing Address
First Line	:	PO BOX 311
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-0311
Country	:	US
Telephone Number	:	931-876-0606
Fax Number	:	918-876-0604

Provider Business Practice Location Address
First Line	:	6846 S CANTON AVE STE 230
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3420
Country	:	US
Telephone Number	:	918-876-0606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2020
Last Update Date	:	05/18/2026

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Directions to “ JUDY K WAGGA ” Practice Location

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