Willow Family Medicine, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

2006013170 Issued in MO

Legal business name

WILLOW FAMILY MEDICINE, LLC

Practice address

304 Teaco Rd
Suite a
Kennett, MO 63857-3266

Phone

(573) 888-0303

Fax

(573) 888-0304

NPI assigned

Aug 31, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Renee Puckett, DO

Title

Physician, Owner

Phone

(573) 888-0303

Specialties & licenses 2

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7445/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Linda Byndom, FNP

  • Family Nurse Practitioner
  • Jackson, MO
  • NPI 1225013063
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202342400000",
    "number": "1720272834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 TEACO RD",
            "address_2": "SUITE A",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573266",
            "telephone_number": "573-888-0303",
            "fax_number": "573-888-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 TEACO RD",
            "address_2": "SUITE A",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573266",
            "telephone_number": "573-888-0303",
            "fax_number": "573-888-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-31",
        "last_updated": "2008-02-07",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PHYSICIAN, OWNER",
        "authorized_official_telephone_number": "573-888-0303",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2006013170",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "2006013170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• McKaela Ann Williams
• Nena Williams
• Scott Joseph Williams, PMHNP-BC
• Kurt W Williamson
• Willow Family Care
• Alex Wilson
• Lora Nicole Wilson
• Tailor Michael Wilson
• Tina R Winkle
• Aneshia Monia Wofford

• Rural Health Clinic/Center in Kennett, MO
• Providers in Kennett, MO by specialty
• Rural Health Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.