Edie Costlow, CST, CFA, LSA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

SA00062 Issued in TX

Practice address

3810 Timberlake Dr
Plano, TX 75023-7727

Phone

(214) 227-2457

Fax

(214) 764-0880

NPI assigned

Aug 13, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1174535298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3810 TIMBERLAKE DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750237727",
            "telephone_number": "214-227-2457",
            "fax_number": "214-764-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 TIMBERLAKE DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750237727",
            "telephone_number": "214-227-2457",
            "fax_number": "214-764-0880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7777 Forest Ln Ste C106",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752306831",
            "country_code": "US",
            "telephone_number": "972-566-5255",
            "fax_number": "972-566-5236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTLOW",
        "first_name": "EDIE",
        "name_prefix": "Mrs.",
        "credential": "CST, CFA, LSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TX",
            "license": "SA00062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Assistant in Plano, TX
• Providers in Plano, TX by specialty
• Surgical Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.