Healthcare Provider Details

I. General information

NPI: 1073300828
Provider Name (Legal Business Name): RESTORED VITALITY MOBILE WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 BOND ST
OVERLAND PARK KS
66214-1707
US

IV. Provider business mailing address

8833 BOND ST
OVERLAND PARK KS
66214-1707
US

V. Phone/Fax

Practice location:
  • Phone: 785-318-0907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAYLA DAVIS-BIMEAL
Title or Position: OWNER
Credential:
Phone: 913-850-9048