Individual
KEVIN COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER, FORT LIBERTY, NC 28310-7324
(910) 907-8922
(910) 907-6069
Mailing address
2817 ROCK MERRIT AVE WOMACK ARMY MEDICAL CENTER, FORT LIBERTY, NC 28310-7324
(910) 907-8922
(910) 907-6069
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
006278
NC
367500000X
Certified Registered Nurse Anesthetist
RN245934
GA
Other
Enumeration date
01/31/2017
Last updated
02/04/2025
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