Provider Demographics
NPI:1275276719
Name:PRIEST, NIKOLAS FOREST
Entity Type:Individual
Prefix:MR
First Name:NIKOLAS
Middle Name:FOREST
Last Name:PRIEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2794 MADISON AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2002
Mailing Address - Country:US
Mailing Address - Phone:917-817-8609
Mailing Address - Fax:
Practice Address - Street 1:3720 ALUMNI AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-5914
Practice Address - Country:US
Practice Address - Phone:901-678-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program