Provider Demographics
NPI:1164437877
Name:COSTELLO, JO NELL (RN, ANP-C, GNP-C)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:NELL
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:RN, ANP-C, GNP-C
Other - Prefix:MISS
Other - First Name:JO
Other - Middle Name:NELL
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 MAHOGANY RUN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6166
Mailing Address - Country:US
Mailing Address - Phone:281-693-1977
Mailing Address - Fax:281-693-2667
Practice Address - Street 1:1107 MAHOGANY RUN DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6166
Practice Address - Country:US
Practice Address - Phone:281-693-1977
Practice Address - Fax:281-693-2667
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604569363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP91841Medicare UPIN