Healthcare Provider Details

I. General information

NPI: 1174486922
Provider Name (Legal Business Name): NANCY JEROTICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 W 106TH ST APT 47
OVERLAND PARK KS
66212-5904
US

IV. Provider business mailing address

7575 W 106TH ST APT 47
OVERLAND PARK KS
66212-5904
US

V. Phone/Fax

Practice location:
  • Phone: 913-325-0534
  • Fax:
Mailing address:
  • Phone: 913-325-0534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: