Provider Demographics
NPI:1346542867
Name:COSTNER, DAVID SIMEON (APRN NP-BC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SIMEON
Last Name:COSTNER
Suffix:
Gender:M
Credentials:APRN NP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0707
Mailing Address - Country:US
Mailing Address - Phone:870-424-7070
Mailing Address - Fax:870-424-6616
Practice Address - Street 1:228 BUCHER DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3400
Practice Address - Country:US
Practice Address - Phone:870-425-4416
Practice Address - Fax:870-425-8615
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-102425363L00000X
MT102425363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner