Individual
JESSICA MICHELLE DEGROAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 S PARK LN, ALTUS, OK 73521-5755
(580) 379-6650
Mailing address
205 S PARK LN, ALTUS, OK 73521-5755
(580) 379-6705
(580) 379-6709
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41596
OK
207Q00000X
Family Medicine Physician
94-10426
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201186270A
—
OK
Enumeration date
06/26/2020
Last updated
10/30/2025
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