Healthcare Provider Details

I. General information

NPI: 1174449581
Provider Name (Legal Business Name): DULANY MARIA POTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 REMINGTON PLZ
RAYMORE MO
64083-8584
US

IV. Provider business mailing address

238 N FOX RIDGE DR APT 211
RAYMORE MO
64083-8695
US

V. Phone/Fax

Practice location:
  • Phone: 816-730-8525
  • Fax:
Mailing address:
  • Phone: 660-351-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: