| Willow Family Medicine, LLC | |
|
304 Teaco Rd Suite A Kennett MO 63857-3266 | |
| (573) 888-0303 | |
| (573) 888-0304 |
| Full Name | Willow Family Medicine, LLC |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 304 Teaco Rd, Kennett, Missouri |
| Authorized Official Name and Position | Jennifer Renee Puckett (PHYSICIAN, OWNER) |
| Authorized Official Contact | 5738880303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Family Medicine, LLC 304 Teaco Rd Suite A Kennett MO 63857-3266 Ph: (573) 888-0303 | Willow Family Medicine, LLC 304 Teaco Rd Suite A Kennett MO 63857-3266 Ph: (573) 888-0303 |
| NPI Number | 1720272834 |
|---|---|
| Provider Enumeration Date | 08/31/2007 |
| Last Update Date | 02/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720272834 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 2006013170 (Missouri) | Primary |
| 207Q00000X | Family Medicine | 2006013170 (Missouri) | Secondary |
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