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

Sex

Female

Sole proprietor

No

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

• Citizens Memorial Healthcare

  • Surgery Physician
  • Bolivar, MO
  • NPI 1568566131

  Family Medicine, MO

  Medicare reassignment NPD
• Citizens Memorial Healthcare

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

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

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 (3 of 5)

Locations

Networks

• IA HMO C-SNP
• IA HMO

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 2, 2026.

{
    "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
• Alvin Nyberg, RPH
• Dwight K Nyberg Jr., R.PH.
• David H Paul, DDS
• Sheri L Pearlstein, M.S.
• Ashley Justine Perkins, DPT
• PHDC, LLC
• Tisha Pinon
• Ashley Michelle Pollock, RDH
• Premier Residential Care LLC

• All providers in Buffalo, MO
• 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.