| Doctor Name: | KATHEREN BACCUS |
| NPI Number: | 1083896567 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | 558304 |
| Business Practice Address: | 1317 N Hillcrest Dr Sulphur Springs, TX - 754822091 |
| Business Phone Number: | 9034381110 |
| Business Fax Number: | 9034381107 |
| Mailing Address: | 1317 N Hillcrest Dr, SULPHUR SPRINGS |
| State: | TX |
| Postal Code: | 754822091 |
| Phone Number: | 9034381110 |
| Fax Number: | 9034381107 |
| NPI Enumeration Date: | 11/27/2007 |
| NPI Last Update Date: | 06/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 558304 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |