Provider Demographics
NPI:1639681372
Name:BATTIST, MARK A
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BATTIST
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 STATE LINE RD # 296
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1254
Mailing Address - Country:US
Mailing Address - Phone:913-302-7183
Mailing Address - Fax:888-779-3217
Practice Address - Street 1:1500 W FOXWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9372
Practice Address - Country:US
Practice Address - Phone:913-302-7183
Practice Address - Fax:888-779-3217
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-119981363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health