| NPI | 1538591227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL RENE HEADY-FENWICK Office Manager 636-337-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 102003) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 144688) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2010037937) | |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-09-10 |