Individual
KRISTOPHER COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3001 AVENUE A, DODGE CITY, KS 67801-2270
(620) 225-8400
Mailing address
904 RAGAN RD, DODGE CITY, KS 67801-2950
(928) 660-2202
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
TMP-155882
KS
Other
Enumeration date
01/11/2018
Last updated
01/11/2018
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