Provider Demographics
NPI:1740164573
Name:QUARLES, AESIA JADE (LPN)
Entity type:Individual
Prefix:
First Name:AESIA
Middle Name:JADE
Last Name:QUARLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 WILSON ST UNIT 18
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7819
Mailing Address - Country:US
Mailing Address - Phone:620-515-1839
Mailing Address - Fax:
Practice Address - Street 1:5912 US-70
Practice Address - Street 2:
Practice Address - City:SILO
Practice Address - State:OK
Practice Address - Zip Code:74701
Practice Address - Country:US
Practice Address - Phone:580-745-9083
Practice Address - Fax:620-515-1839
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK219111164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse