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Organization
FAMILIES 1ST OF DESOTO, LLC.
Active
Organization
FAMILIES 1ST OF DESOTO, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL RENE HEADY-FENWICK (OFFICE MANAGER)
(636) 337-7800
Entity
Organization
Contact information
Practice address
127 W PRATT ST, DE SOTO, MO 63020-2107
(636) 337-7800
(636) 337-7804
Mailing address
127 W PRATT ST, DE SOTO, MO 63020-2107
(636) 337-7800
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
102003
MO
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
144688
MO
363LF0000X
Family Nurse Practitioner
2010037937
MO
Other
Enumeration date
08/05/2013
Last updated
09/10/2013
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