Individual
MICHELLE LYN COSTLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
121 S BROADWAY AVE STE 608, TYLER, TX 75702-7281
(888) 360-7587
(979) 446-0280
Mailing address
1511 TEXAS AVE S PMB 233, PMB 233, BRYAN, TX 77802-3475
(888) 360-7587
(979) 446-0280
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1099356
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
74683
NM
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
C-APN.0101005-C-NP
CO
Other
Enumeration date
01/25/2023
Last updated
12/12/2025
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