Healthcare Provider Details

I. General information

NPI: 1821844614
Provider Name (Legal Business Name): VULNERARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 05/04/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W FOXWOOD DR STE B
RAYMORE MO
64083-9372
US

IV. Provider business mailing address

12120 STATE LINE RD # 296
LEAWOOD KS
66209-1254
US

V. Phone/Fax

Practice location:
  • Phone: 850-377-0925
  • Fax:
Mailing address:
  • Phone: 850-377-0925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARK A BATTIST
Title or Position: OWNER
Credential: NP
Phone: 850-377-0925