Individual
JANESSA BACCUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
210 BRYAN, LOCUST GROVE, OK 74352-5154
(918) 824-5953
Mailing address
210 BRYAN, LOCUST GROVE, OK 74352-5154
(918) 824-5953
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
08/04/2025
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