Healthcare Provider Details

I. General information

NPI: 1992900492
Provider Name (Legal Business Name): PATRICE WANETTA DUMAS VERAGUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. PATRICE WANETTA DUMAS

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18813 E 25TH ST S
INDEPENDENCE MO
64057-2467
US

IV. Provider business mailing address

18813 E 25TH ST S
INDEPENDENCE MO
64057-2467
US

V. Phone/Fax

Practice location:
  • Phone: 816-217-1791
  • Fax: 816-817-0027
Mailing address:
  • Phone: 816-217-1791
  • Fax: 816-817-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024035031
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5383569011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: