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General NPI Number Information
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NPI Number | 1003279498
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Entity Type | Individual
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Provider Name | JARED QUALLS APRN
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Gender | Male
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 1145 S UTICA AVE SUITE 460
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City | TULSA
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State | OK
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Zip | 74104-4000
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Country | US
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Telephone | 918-579-5749
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Fax | 918-579-5762
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Provider Business Mailing Address
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Address Line | 1145 S UTICA AVE SUITE 460
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City | TULSA
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State | OK
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Zip | 74104-4000
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Country | US
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Telephone | 918-579-5749
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Fax | 918-579-5762
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 102252
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 102252
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License Number State | OK
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