# FAMILIES 1ST OF DESOTO, LLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538591227
- **Authorized official:** MRS. CRYSTAL RENE HEADY-FENWICK (OFFICE MANAGER)
- **Authorized official phone:** (636) 337-7800

## Contact information

- **Practice address:** 127 W PRATT ST, DE SOTO, MO 63020-2107
- **Practice address phone:** (636) 337-7800
- **Practice address fax:** (636) 337-7804
- **Mailing address:** 127 W PRATT ST, DE SOTO, MO 63020-2107
- **Mailing address phone:** (636) 337-7800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 102003 | MO | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | 144688 | MO | — |
| 363LF0000X | Family Nurse Practitioner | 2010037937 | MO | — |

## Other

- **Enumeration date:** 08/05/2013
- **Last updated:** 09/10/2013