# WILLOW FAMILY MEDICINE, LLC

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

## Provider details

- **NPI number:** 1720272834
- **Authorized official:** JENNIFER RENEE PUCKETT DO (PHYSICIAN, OWNER)
- **Authorized official phone:** (573) 888-0303

## Contact information

- **Practice address:** 304 TEACO RD, SUITE A, KENNETT, MO 63857-3266
- **Practice address phone:** (573) 888-0303
- **Practice address fax:** (573) 888-0304
- **Mailing address:** 304 TEACO RD, SUITE A, KENNETT, MO 63857-3266
- **Mailing address phone:** (573) 888-0303
- **Mailing address fax:** (573) 888-0304

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2006013170 | MO | — |
| 261QR1300X | Rural Health Clinic/Center | 2006013170 | MO | Yes |

## Other

- **Enumeration date:** 08/31/2007
- **Last updated:** 02/07/2008