Healthcare Provider Details

I. General information

NPI: 1538944665
Provider Name (Legal Business Name): AMANDA MARIE FITE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 NE 12TH ST
MOORE OK
73160-5807
US

IV. Provider business mailing address

18961 NE 23RD ST
HARRAH OK
73045-8109
US

V. Phone/Fax

Practice location:
  • Phone: 405-237-9955
  • Fax:
Mailing address:
  • Phone: 405-772-4650
  • Fax: 405-772-4653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214342
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: