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Individual
KATHLEEN C BACCUS
Active
Individual
KATHLEEN C BACCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1005508
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1F5915
MEDICARE
TX
Enumeration date
07/14/2020
Last updated
09/01/2020
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