Healthcare Provider Details

I. General information

NPI: 1841092277
Provider Name (Legal Business Name): SHERI BROCKETT RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9051 NE 81ST TER STE 100
KANSAS CITY MO
64158-1168
US

IV. Provider business mailing address

8271 N TULLIS AVE UNIT 231
KANSAS CITY MO
64158-7713
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-1170
  • Fax: 816-792-1170
Mailing address:
  • Phone: 816-210-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2009021770
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: