Individual
JARED QUALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1145 S UTICA AVE, SUITE 460, TULSA, OK 74104-4000
(918) 579-5749
(918) 579-5762
Mailing address
1145 S UTICA AVE, SUITE 460, TULSA, OK 74104-4000
(918) 579-5749
(918) 579-5762
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
102252
OK
363LF0000X
Family Nurse Practitioner
102252
OK
Other
Enumeration date
04/01/2016
Last updated
06/21/2019
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