MR. EDWARD T COSTELLO (NPI# 1730104340) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730104340 |
| Entity Type | Individual |
| Full Name | MR. EDWARD T COSTELLO |
| Credential | P.A. |
| Practice Address |
1002 Schneider Dr Suite 104 Malvern AR 72104-4816 |
| Practice Telephone | 5013327981 |
| Practice Fax Number | 5013379964 |
| Mailing Telephone | 5013327981 |
| Mailing Fax Number | 5013379964 |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2013-07-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA-251 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1002 SCHNEIDER DR SUITE 104 |
| City | MALVERN |
| State | AR |
| Zip Code | 72104-4816 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720054125 | Altimus Ray Bollen | Internal Medicine | 1002 Schneider Dr, Suite 104, Malvern, AR 72104-4816 | 2006-02-24 |
| 1629536255 | Amanda R Masters-stephens | Nurse Practitioner | 1002 Schneider Dr, Malvern, AR 72104-4816 | 2019-03-02 |
| 1013460849 | Presidential Emergency Physicians, LLC | Nurse Practitioner | 1002 Schneider Dr, Malvern, AR 72104-4816 | 2016-07-28 |
| 1881002756 | Heather Grigsby | Nurse Practitioner | 1002 Schneider Dr, Malvern, AR 72104-4816 | 2014-07-23 |
| 1053692137 | Hot Spring County Medical Services | Surgery | 1002 Schneider Dr, Suite 102, Malvern, AR 72104-4816 | 2011-09-02 |
| 1104106426 | Shane Higginbotham Md Pa | Physician Assistant | 1002 Schneider Dr, Malvern, AR 72104-4816 | 2011-08-17 |
| 1811168537 | Courtney C Bickerstaff | Nurse Practitioner | 1002 Schneider Dr, Suite 104, Malvern, AR 72104-4816 | 2008-03-20 |
| 1033129713 | Shane Higginbotham Md Pa | Physician Assistant | 1002 Schneider Dr, Suite 104, Malvern, AR 72104-4816 | 2006-08-08 |
| 1881660058 | Bruce Allen White | Family Medicine | 1002 Schneider Dr, Suite 104, Malvern, AR 72104-4816 | 2006-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659907707 | Terrence Randell Mitchell | Prosthetist | 991 Mount Willow Rd., Malvern, AR 72104 | 2020-03-20 |
| 1356837959 | American Oncology Partners, P.a. | Internal Medicine | 1001 Schneider Dr Ste 105, Malvern, AR 72104 | 2018-07-06 |
| 1114262839 | Charloda Nolen | Case Manager/Care Coordinator | 1710 E Page, Malvern, AR 72104 | 2012-12-06 |
| 1427349257 | Malvern Physical Therapy and Wellness | Physical Therapist | 1601 Hwy 270 W, Suite 104, Malvern, AR 72104 | 2011-04-27 |
| 1194037069 | Alternative Opportunities | Community/Behavioral Health | 1519 East Page Avenue, Malvern, AR 72104 | 2010-07-08 |
| 1285878991 | Pro-active Rehab Inc. | Physical Therapist | 720 Walco Rd, Suite 240, Malvern, AR 72104 | 2009-04-24 |
| 1932380599 | Vallerie Ahart | Licensed Practical Nurse | 1022 East Page, Malvern, AR 72104 | 2007-11-23 |
| 1104013598 | Vivian Brown | Home Health Aide | 913 Magnolia, Malvern, AR 72104 | 2007-09-28 |
| 1467665919 | Annette Jean Bowersox | Registered Nurse | 1399 Jenny Road, Malvern, AK 72104 | 2007-05-08 |
| 1730305798 | Jacqueline Kilgore LLC | Skilled Nursing Facility | 912 Section Line St, Malvern, AR 72104 | 2007-04-18 |
| Find all providers in zip 72104 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346735735 | Haley Beth Hobson | Physician Assistant | 1308 E Page Ave, Malvern, AR 72104-4518 | 2018-06-27 |
| 1720209471 | Anna M. Bui | Physician Assistant | 266 Lancaster Ave Ste 200, Malvern, PA 19355-3256 | 2007-05-01 |
| 1144821422 | Sarah Mae Christie | Physician Assistant | 940 W King Rd, Malvern, PA 19355-3166 | 2020-11-04 |
| 1639560733 | Candace Taylor Lambert | Physician Assistant | 1234 S Main St, Malvern, AR 72104-5226 | 2015-02-10 |
| 1588073738 | Leah Harmon Costello | Physician Assistant | 1002 Schneider Dr Ste 104, Malvern, AR 72104-4823 | 2014-08-12 |
| 1376805911 | Mendy Beth Corter | Physician Assistant | 1003 Schneider Dr, Malvern, AR 72104-4811 | 2012-06-11 |
| 1043594492 | Jennifer Levash | Physician Assistant | 266 Lancaster Ave Ste 200, Malvern, PA 19355-3256 | 2011-10-04 |
| 1104106426 | Shane Higginbotham Md Pa | Physician Assistant | 1002 Schneider Dr, Malvern, AR 72104-4816 | 2011-08-17 |
| 1639381700 | Luana A Johnson | Physician Assistant | 266 Lancaster Ave Ste 200, Malvern, PA 19355-3256 | 2007-05-03 |
| 1912128653 | Christiane Marie Petrillo | Physician Assistant | 266 Lancaster Ave, Malvern, PA 19355-3256 | 2007-05-01 |
| Find all providers in MALVERN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.