Healthcare Provider Details

I. General information

NPI: 1558104679
Provider Name (Legal Business Name): HEATHER DIANE LACKEY BSN,RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8781 N PLATTE PURCHASE DR
KANSAS CITY MO
64155-1829
US

IV. Provider business mailing address

8781 N PLATTE PURCHASE DR
KANSAS CITY MO
64155-1829
US

V. Phone/Fax

Practice location:
  • Phone: 816-587-3200
  • Fax: 816-587-7644
Mailing address:
  • Phone: 816-587-3200
  • Fax: 816-587-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL35167
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: