Provider Demographics
NPI:1619319753
Name:COSTELLO, KRISTEN JO (DNP, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JO
Last Name:COSTELLO
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Gender:F
Credentials:DNP, ACNP-BC
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5757 W THUNDERBIRD RD STE E456
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4650
Mailing Address - Country:US
Mailing Address - Phone:028-656-4570
Mailing Address - Fax:602-865-4575
Practice Address - Street 1:5757 W THUNDERBIRD RD STE E456
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4650
Practice Address - Country:US
Practice Address - Phone:028-656-4570
Practice Address - Fax:602-865-4575
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP5063363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care