=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912461997
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARYN GORT DNP, APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2019
-----------------------------------------------------
Last Update Date | 03/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5808 W 110TH ST
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66211-2504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-696-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5808 W 110TH ST
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66211-2504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-696-8220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Registered Nurse
-----------------------------------------------------
License Number | 14-125268-041
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0206X
-----------------------------------------------------
Taxonomy Name | Pediatric Gastroenterology Physician
-----------------------------------------------------
License Number | 53-79480-041
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------