=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841092277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERI BROCKETT RN IBCLC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9051 NE 81ST TER STE 100
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64158-1168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-792-1170
-----------------------------------------------------
Fax | 816-792-1170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8271 N TULLIS AVE UNIT 231
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64158-7713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-210-1148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WL0100X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Registered Nurse)
-----------------------------------------------------
License Number | 2009021770
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------