Provider Demographics
NPI:1902454309
Name:DUGAS, RAMONDA LYNN (NP)
Entity Type:Individual
Prefix:
First Name:RAMONDA
Middle Name:LYNN
Last Name:DUGAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1399
Mailing Address - Country:US
Mailing Address - Phone:417-466-7191
Mailing Address - Fax:417-466-3876
Practice Address - Street 1:1011 S EAST ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1399
Practice Address - Country:US
Practice Address - Phone:417-466-7191
Practice Address - Fax:417-466-3876
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019033626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO590665907Medicaid
MO810548866Medicaid