Organization
WILLOW FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RENEE PUCKETT DO (PHYSICIAN, OWNER)
(573) 888-0303
Entity
Organization
Contact information
Practice address
304 TEACO RD, SUITE A, KENNETT, MO 63857-3266
(573) 888-0303
(573) 888-0304
Mailing address
304 TEACO RD, SUITE A, KENNETT, MO 63857-3266
(573) 888-0303
(573) 888-0304
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2006013170
MO
261QR1300X
Rural Health Clinic/Center
Primary
2006013170
MO
Other
Enumeration date
08/31/2007
Last updated
02/07/2008
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