Organization
ABMBA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHTON MAKAILA BERGH APRN (OWNER/NURSE PRACTITIONER/ RNFA)
(913) 548-6230
Entity
Organization
Contact information
Practice address
11217 LAKEVIEW AVE, LENEXA, KS 66219-1399
(913) 432-7200
(877) 492-3737
Mailing address
3990 W 255TH ST, LOUISBURG, KS 66053-6293
(913) 548-6230
(877) 492-3737
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750890554
—
KS
Enumeration date
04/19/2021
Last updated
09/13/2021
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