Healthcare Provider Details

I. General information

NPI: 1346542867
Provider Name (Legal Business Name): DAVID SIMEON COSTNER APRN NP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2010
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W RAILROAD AVE
PLAINS MT
59859-9597
US

IV. Provider business mailing address

406 W RAILROAD AVE
PLAINS MT
59859-9597
US

V. Phone/Fax

Practice location:
  • Phone: 406-540-5757
  • Fax: 833-906-2418
Mailing address:
  • Phone: 406-540-5757
  • Fax: 833-906-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-102425
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number102425
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: