Provider Demographics
NPI:1336998236
Name:ARISE PSYCHIATRY PLLC
Entity type:Organization
Organization Name:ARISE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADAOBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEMENAM
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:310-800-8445
Mailing Address - Street 1:200 S OAKRIDGE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-2501
Mailing Address - Country:US
Mailing Address - Phone:310-800-8445
Mailing Address - Fax:
Practice Address - Street 1:1617 PARK PLACE AVE
Practice Address - Street 2:SUITE #110
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110
Practice Address - Country:US
Practice Address - Phone:682-302-0301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty