| Organization Name: | FENTON FAMILY PRACTICE, LLC |
| NPI Number: | 1356493811 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENDA LYNN BUCKLEY (DOCTOR) |
| Mailing Address: | 1747 Smizer Station Rd Suite 5 Fenton |
| State: | MO US |
| Postal Code: | 630262784 |
| Phone Number: | 6365297000 |
| Fax Number: | 6365297003 |
| NPI Enumeration Date: | 01/17/2007 |
| NPI Last Update Date: | 09/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 115447 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |