Provider Demographics
NPI:1053544544
Name:BRACKETT, LORI ELIZABETH (ARNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ELIZABETH
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2124
Mailing Address - Country:US
Mailing Address - Phone:913-814-3788
Mailing Address - Fax:913-814-3766
Practice Address - Street 1:7935 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2124
Practice Address - Country:US
Practice Address - Phone:913-814-3788
Practice Address - Fax:913-814-3766
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74957-092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200621170BMedicaid
KS200621170BMedicaid
MOMA4620018Medicare PIN
MO1053544544Medicare PIN