Basic Information
| Provider Information | |||||||||
| NPI: | 1073810404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GICHEMA | ||||||||
| FirstName: | CATHY | ||||||||
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| Credential: | ANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5201 HARRY HINES BLVD | ||||||||
| Address2: | CHEST MEDICINE CLINIC, 4TH FLOOR | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357708 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 221 W COLORADO BLVD STE 525 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752082312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149564525 | ||||||||
| FaxNumber: | 2149605681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2011 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 790561 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | DQ5280 | 01 | TX | MEDICARE RR PALMETTO | OTHER | 280980801 | 05 | TX | MEDICAID | D07564 | 01 | TX | MEDICARE RR PALMETTO | OTHER |