Basic Information
| Provider Information | |||||||||
| NPI: | 1891325510 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUICK | ||||||||
| FirstName: | PRESTON | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17183 S. KIMBLE ST. | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136380574 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20375 WEST 151ST. STE 105 | ||||||||
| Address2: | |||||||||
| City: | OLETHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135575678 | ||||||||
| FaxNumber: | 9135575681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2020 | ||||||||
| LastUpdateDate: | 07/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 13-130493-011 | KS | N | Nursing Service Providers | Registered Nurse | 163W00000X | 20150225973 | MO | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 5379258 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 201275000A | 05 | KS | MEDICAID |