Healthcare Provider Details

I. General information

NPI: 1932479698
Provider Name (Legal Business Name): DEXTER R-XI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BROWN PILOT LN
DEXTER MO
63841-1803
US

IV. Provider business mailing address

1031 BROWN PILOT LN
DEXTER MO
63841-1803
US

V. Phone/Fax

Practice location:
  • Phone: 573-614-1000
  • Fax: 573-614-1002
Mailing address:
  • Phone: 573-614-1000
  • Fax: 573-614-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY A FLOWERS
Title or Position: ASSISTANT SUPERINTENDENT
Credential:
Phone: 573-614-1000