Organization Active NPI

Riseabove Mental Health and Wellness, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Eagle, ID
National Provider Identifier
1124925284
Registry record updated Oct 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
RISEABOVE MENTAL HEALTH AND WELLNESS, PLLC
Practice address
500 E Shore Dr Ste 200
Eagle, ID 83616-6960
Phone
(208) 486-5894
NPI assigned
Oct 22, 2026
Last updated
Oct 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marcela L Azevedo, PMHNP-BC
Title
Managing Member
Phone
(208) 486-5894

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

500 E Shore Dr Ste 200
Eagle, ID 83616-6960

Mailing address

500 E Shore Dr Ste 200
Eagle, ID 83616-6960
Phone (208) 486-5894

National Provider Directory

National Provider Directory

Locations

500 E Shore Dr
Ste 200
Eagle, ID 83616

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1792627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792627200000",
    "number": "1124925284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E SHORE DR STE 200",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166960",
            "telephone_number": "208-486-5894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E SHORE DR STE 200",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166960",
            "telephone_number": "208-486-5894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RISEABOVE MENTAL HEALTH AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-22",
        "last_updated": "2026-10-22",
        "certification_date": "2026-10-06",
        "status": "A",
        "authorized_official_last_name": "AZEVEDO",
        "authorized_official_first_name": "MARCELA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "208-486-5894",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.