Taylor Nicole Pedersen, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2020009910 Issued in MO

Practice address

201 S Ash St
Buffalo, MO 65622-8674

Phone

(417) 345-4858

Fax

(417) 345-6866

NPI assigned

Jun 19, 2017

Last updated

Mar 2, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• IA HMO C-SNP
• IA HMO

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Citizens Memorial Healthcare

  • Surgery Physician
  • Bolivar, MO
  • NPI 1568566131

  Family Medicine

  Medicare reassignment NPD
• Citizens Memorial Healthcare

  dba CMH Willard Medical Center

  • Rural Health Clinic/Center
  • Willard, MO
  • NPI 1568127397
  NPD
• Citizens Memorial Hospital District

  dba Citizens Memorial Hospital

  • General Acute Care Hospital
  • Bolivar, MO
  • NPI 1003981549
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772409600000",
    "number": "1043740202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S ASH ST",
            "city": "BUFFALO",
            "state": "MO",
            "postal_code": "656228674",
            "telephone_number": "417-345-4858",
            "fax_number": "417-345-6866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S ASH ST",
            "city": "BUFFALO",
            "state": "MO",
            "postal_code": "656228674",
            "telephone_number": "417-345-4858",
            "fax_number": "417-345-6866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "TAYLOR",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-19",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2020009910",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "12327A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nyberg Pharmacy Inc (Nyberg Pharmacy)
• Alvin Nyberg, RPH
• Dwight K Nyberg Jr., R.PH.
• David H Paul, DDS
• Sheri L Pearlstein, M.S.
• Ashley Justine Perkins, DPT
• PHDC, LLC (Buffalo Prairie Care Center)
• Tisha Pinon
• Ashley Michelle Pollock, RDH
• Premier Residential Care LLC (Pine Lodge Residential Care)

• Family Medicine Physician in Buffalo, MO
• Providers in Buffalo, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.