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General NPI Number Information
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NPI Number | 1346542867
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Entity Type | Individual
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Provider Name | DAVID SIMEON COSTNER APRN NP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/04/2010
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 228 BUCHER DR
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-3400
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Country | US
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Telephone | 870-425-4416
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Fax | 870-425-8615
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Provider Business Mailing Address
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Address Line | PO BOX 707
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City | MOUNTAIN HOME
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State | AR
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Zip | 72654-0707
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Country | US
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Telephone | 870-424-7070
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Fax | 870-424-6616
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NUR-APRN-LIC-102425
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 102425
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License Number State | MT
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