Provider Demographics
NPI:1841871068
Name:ABMBA LLC
Entity type:Organization
Organization Name:ABMBA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER/ RNFA
Authorized Official - Prefix:
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:MAKAILA
Authorized Official - Last Name:BERGH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:913-548-6230
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 1:11217 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1399
Practice Address - Country:US
Practice Address - Phone:913-432-7200
Practice Address - Fax:877-492-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1750890554Medicaid