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General NPI Number Information
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NPI Number | 1912486093
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Entity Type | Organization
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Legal Business Name | FAMILIES 1ST OF DESOTO, LLC.
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 127 W PRATT ST
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City | DE SOTO
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State | MO
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Zip | 63020-2107
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Country | US
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Telephone | 636-337-7800
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Fax | 636-586-2276
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Provider Business Mailing Address
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Address Line | 127 W PRATT ST
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City | DE SOTO
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State | MO
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Zip | 63020-2107
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Country | US
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Telephone | 636-337-7800
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Fax | 636-586-2276
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Authorized Official
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Title or Position | OWNER/ANP
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Name | MS. KATHLEEN MARIE O'ROURKE
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Credential | ANP
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Telephone | 636-337-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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