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General NPI Number Information
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NPI Number | 1043038334
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Entity Type | Individual
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Provider Name | TRISTA KOSTELLO NP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 701 S NEW BALLAS RD STE 510
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8726
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Country | US
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Telephone | 314-251-6710
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Fax |
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Provider Business Mailing Address
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Address Line | 572 SPRAGUES MILL CT
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City | BALLWIN
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State | MO
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Zip | 63011-3327
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Country | US
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Telephone | 636-751-4336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2015022116
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2024043059
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License Number State | MO
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