Individual
MRS. LEAH HARMON COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1002 SCHNEIDER DR STE 104, MALVERN, AR 72104-4823
(501) 332-7981
(501) 337-9964
Mailing address
1002 SCHNEIDER DR STE 104, MALVERN, AR 72104-4823
(501) 337-9994
(501) 337-9964
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-565
AR
Other
Enumeration date
08/12/2014
Last updated
05/17/2021
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