Individual
TAYLOR JERSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
(816) 302-9939
Mailing address
2401 GILLHAM RD, PROVIDER ENROLLMENT DEPT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35129920
OH
208000000X
Pediatrics Physician
Primary
35129920
OH
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
04-45140
KS
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
2021034941
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0337517
—
OH
Enumeration date
04/09/2015
Last updated
04/13/2026
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