Healthcare Provider Details

I. General information

NPI: 1508354820
Provider Name (Legal Business Name): BROOKE DANIELLE STREETT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N 36TH ST
SAINT JOSEPH MO
64506-2977
US

IV. Provider business mailing address

711 N 36TH ST
SAINT JOSEPH MO
64506-2977
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-4022
  • Fax: 816-271-4020
Mailing address:
  • Phone: 816-271-4022
  • Fax: 816-271-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019043340
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: