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WILLOW FAMILY MEDICINE LLC NPI 1720272834


NPI Information

NPI: 1720272834
Provider Name: WILLOW FAMILY MEDICINE, LLC
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
304 TEACO RD
SUITE A
KENNETT, MO
ZIP 63857
Phone: (573) 888-0303
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WILLOW FAMILY MEDICINE, LLC is a rural health clinic center in Kennett, MO. WILLOW FAMILY MEDICINE, LLC NPI is 1720272834. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

304 TEACO RD
SUITE A
KENNETT, MO
ZIP 63857-266
Phone: (573) 888-0303
Fax: (573) 888-0304

The provider's authorized official is Jennifer Renee Puckett .
The authorized official title is Physician, Owner and has the following contact phone number (573) 888-0303.

The enumeration date for this NPI number is 8/31/2007 and was last updated on 2/7/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine2006013170MISSOURINo
2261QR1300XClinic/CenterRural Health2006013170MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1268968MEDICARE OSCAR/CERTIFICATIONMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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