Organization
KENNETT PEDIATRIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY D LEDBETTER (DIRECTOR OF OPERATIONS)
(573) 651-4488
Entity
Organization
Contact information
Practice address
211 TEACO RD, KENNETT, MO 63857-3236
(573) 888-0004
(573) 888-0006
Mailing address
211 TEACO RD, KENNETT, MO 63857-3236
(573) 888-0004
(573) 888-0006
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
509371407
—
MO
Enumeration date
04/23/2008
Last updated
04/23/2008
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