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General NPI Number Information
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NPI Number | 1811876824
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Entity Type | Organization
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Legal Business Name | VITALITY MOBILE WOUND CARE LLC
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1206 SEAGULL CIR
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City | WHITEHOUSE
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State | TX
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Zip | 75791-3544
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Country | US
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Telephone | 903-630-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78731-4298
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JEANNE LEE
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Credential |
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Telephone | 904-574-1563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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