Healthcare Provider Details

I. General information

NPI: 1700711058
Provider Name (Legal Business Name): NATHAN QUIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S BOSTON AVE STE 923
TULSA OK
74103-4114
US

IV. Provider business mailing address

211 S GREENWOOD AVE APT 106
TULSA OK
74120-1450
US

V. Phone/Fax

Practice location:
  • Phone: 918-428-6087
  • Fax:
Mailing address:
  • Phone: 918-229-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: