Provider Demographics
NPI:1396420071
Name:MABB, ASHLEIGH MEREDITH
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:MEREDITH
Last Name:MABB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S SECTION LINE ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-3408
Mailing Address - Country:US
Mailing Address - Phone:785-656-3666
Mailing Address - Fax:
Practice Address - Street 1:3216 VINE ST STE 20
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1988
Practice Address - Country:US
Practice Address - Phone:785-261-7065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-82163-091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily