Individual
CARLA C COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
320 N HOOD ST, LAKE PROVIDENCE, LA 71254-2140
(318) 559-2404
Mailing address
320 N HOOD ST, LAKE PROVIDENCE, LA 71254-2140
(318) 559-2404
(318) 559-2430
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN095103 AP06260
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2121286
—
LA
01
—
AP06260
STATE LICENSE
LA
Enumeration date
08/24/2010
Last updated
10/16/2019
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