Healthcare Provider Details

I. General information

NPI: 1720907694
Provider Name (Legal Business Name): JENNAH ANN IRSIK AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR STE 625
NORTH KANSAS CITY MO
64116-3278
US

IV. Provider business mailing address

2800 CLAY EDWARDS DRIVE, CENTRAL VERIFICATION OFFICE AND PAYOR ENROLLMENT
NORTH KANSAS CITY MO
64116
US

V. Phone/Fax

Practice location:
  • Phone: 816-455-3990
  • Fax:
Mailing address:
  • Phone: 816-691-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2026028102
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: