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General NPI Number Information
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NPI Number | 1922469402
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Entity Type | Individual
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Provider Name | KRISTINE M COSTELLO ANP
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Gender | Female
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 5213 GODFREY RD STE 110
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City | GODFREY
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State | IL
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Zip | 62035-2510
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Country | US
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Telephone | 618-619-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 670 MASON RIDGE CENTER DR STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8573
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Country | US
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Telephone | 618-463-7800
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Fax | 618-467-0073
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2016000994
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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 | 209013674
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License Number State | IL
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