Individual
KRISTINE M COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
5213 GODFREY RD STE 110, GODFREY, IL 62035-2510
(618) 619-3330
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(618) 463-7800
(618) 467-0073
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
2016000994
MO
363LF0000X
Family Nurse Practitioner
Primary
209013674
IL
Other
Enumeration date
03/11/2016
Last updated
09/26/2025
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