MEDICARE: ARISE AND THRIVE MENTAL HEALTH AND WELLNESS SERVICES

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	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1417899592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARISE AND THRIVE MENTAL HEALTH AND WELLNESS SERVICES

Provider Business Mailing Address
First Line	:	15908 LANGLEY WAY
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-0023
Country	:	US
Telephone Number	:	405-535-4776
Fax Number	:	405-535-4776

Provider Business Practice Location Address
First Line	:	3332 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3127
Country	:	US
Telephone Number	:	405-535-4776
Fax Number	:	405-535-4776

Authorized Official
Title or Position	:	APRN
Name	:	DR. FIDELIA NITAH
Credential	:	DNP
Telephone Number	:	405-535-4776

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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