Provider Demographics
NPI:1639681372
Name:BATTIST, MARK A
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BATTIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 875743
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-5743
Mailing Address - Country:US
Mailing Address - Phone:913-215-5008
Mailing Address - Fax:816-447-3960
Practice Address - Street 1:10977 GRANADA LN STE 105
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1415
Practice Address - Country:US
Practice Address - Phone:913-215-5008
Practice Address - Fax:816-447-3960
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-119981363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health