Healthcare Provider Details

I. General information

NPI: 1134713373
Provider Name (Legal Business Name): FIDELIA NABI NITAH PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S BRYANT AVE
EDMOND OK
73034-6309
US

IV. Provider business mailing address

1 S BRYANT AVE
EDMOND OK
73034-6309
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-5370
  • Fax: 405-359-5481
Mailing address:
  • Phone: 405-359-5370
  • Fax: 405-359-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200703
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200703
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: