Provider Demographics
NPI:1992900492
Name:DUMAS VERAGUTH, PATRICE WANETTA
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:WANETTA
Last Name:DUMAS VERAGUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PATRICE
Other - Middle Name:WANETTA
Other - Last Name:DUMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18813 E 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2467
Mailing Address - Country:US
Mailing Address - Phone:816-217-1791
Mailing Address - Fax:816-817-0027
Practice Address - Street 1:18813 E 25TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2467
Practice Address - Country:US
Practice Address - Phone:816-217-1791
Practice Address - Fax:816-817-0027
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 104100000X, 251C00000X
MO363LP0808X363LP0808X
MO2007018861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health