ABISOLA E ABIMBOLA – Family Nurse Practitioner, NPI 1083440457

ABISOLA E ABIMBOLA is a healthcare provider. based in Saint louis, Missouri. specializing in NURSE PRACTITIONER. They hold a License No. 2024037599 (MO). The NPI Number for ABISOLA E ABIMBOLA is 1083440457

Main info

Female
Sole Proprietor
2 Years Of Experience
Accepts Medicare Assignment
Name
ABISOLA E ABIMBOLA
NPI
1083440457
Phone
(732) 763-0359
Address
6015 STAELY AVE
Enumeration Date
11 September 2024
Last Update Date
11 December 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3148212886
Graduation Year
2024 (2 years ago)
PAC ID
8921535469
Group Practice PAC ID
1052605383
Professional Enrollment ID
I20241223002718
Address ID
MO631311706DE13230RDXX300
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience48
Completeness75
Years active:1State licenses:4Digital endpointsOther names

7,017 NURSE PRACTITIONER in MO

Provider Addresses for ABISOLA E ABIMBOLA

  • 6015 STAELY AVE

    SAINT LOUIS, MO 631233460

    Phone: (732) 763-0359

    Type: Mailing

  • 7334 S LINDBERGH BLVD

    SAINT LOUIS, MO 631254522

    Phone: (866) 389-2727

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-09-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20241223002718INurse PractitionerMOTBD
I20250911002272INurse PractitionerILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 63123)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1052605383View full group profile
NameSpecialtyState
Nurse PractitionerMO
Nurse PractitionerMO
Nurse PractitionerMO
Nurse PractitionerMO
Nurse PractitionerKS
Nurse PractitionerMO
Nurse PractitionerMO
Nurse PractitionerMO
Nurse PractitionerTN
Nurse PractitionerMO

Reviews

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Frequently asked questions

What unique ID ties claims to ABISOLA E ABIMBOLA?
NPI 1083440457 is assigned to ABISOLA E ABIMBOLA under the national enumeration system.
Is ABISOLA E ABIMBOLA's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Does ABISOLA E ABIMBOLA list a primary specialty?
If you are matching referrals, note Family Nurse Practitioner for ABISOLA E ABIMBOLA. Clinical services aligned with this taxonomy classification.
What location shows for ABISOLA E ABIMBOLA?
We surface Saint Louis, Missouri for ABISOLA E ABIMBOLA based on available NPPES addresses.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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