Provider Demographics
NPI:1891325510
Name:QUICK, PRESTON JOHN (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:JOHN
Last Name:QUICK
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17183 S. KIMBLE ST.
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-638-0574
Mailing Address - Fax:
Practice Address - Street 1:20375 WEST 151ST. STE 105
Practice Address - Street 2:
Practice Address - City:OLETHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-557-5678
Practice Address - Fax:913-557-5681
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-130493-011163W00000X
MO20150225973163W00000X
KS5379258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201275000AMedicaid