Provider Demographics
NPI:1588073738
Name:COSTELLO, LEAH HARMON (PA)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:HARMON
Last Name:COSTELLO
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1002 SCHNEIDER DR STE 104
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-4823
Mailing Address - Country:US
Mailing Address - Phone:501-337-9994
Mailing Address - Fax:501-337-9964
Practice Address - Street 1:1002 SCHNEIDER DR STE 104
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4823
Practice Address - Country:US
Practice Address - Phone:501-332-7981
Practice Address - Fax:501-337-9964
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2021-05-17
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Provider Licenses
StateLicense IDTaxonomies
ARPA-565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant