Provider Demographics
NPI:1750890554
Name:BERGH, ASHTON MAKAILA (FNP - BC, C)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:MAKAILA
Last Name:BERGH
Suffix:
Gender:F
Credentials:FNP - BC, C
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:MAKAILA
Other - Last Name:SHADFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3990 W 255TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-6293
Mailing Address - Country:US
Mailing Address - Phone:913-548-6230
Mailing Address - Fax:877-492-3737
Practice Address - Street 1:10951 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1331
Practice Address - Country:US
Practice Address - Phone:913-432-7200
Practice Address - Fax:877-492-3737
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily