Michelle Lyn Costlow, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1099356 Issued in TX

Practice address

121 S Broadway Ave Ste 608
Tyler, TX 75702-7281

Phone

(888) 360-7587

Fax

(979) 446-0280

NPI assigned

Jan 25, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NM, CO, TX3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Morgan Virtual Psychiatry PLLCGroup PAC ID 8325456445, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Morgan Virtual Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bryan, TX
  • NPI 1073117222

  CO, NM

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765497600000",
    "number": "1447966262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 TEXAS AVE S PMB 233",
            "address_2": "PMB 233",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023475",
            "telephone_number": "888-360-7587",
            "fax_number": "979-446-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 S BROADWAY AVE STE 608",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757027281",
            "telephone_number": "888-360-7587",
            "fax_number": "979-446-0280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Marquette Ave NW Ste 1200",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871025312",
            "country_code": "US",
            "telephone_number": "888-360-7587",
            "fax_number": "979-446-0280",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7535 E Hampden Ave Ste 400",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802314844",
            "country_code": "US",
            "telephone_number": "888-360-7587",
            "fax_number": "979-446-0280",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3201 University Dr E Ste 240",
            "address_purpose": "LOCATION",
            "city": "Bryan",
            "state": "TX",
            "postal_code": "778023475",
            "country_code": "US",
            "telephone_number": "888-360-7587",
            "fax_number": "979-446-0280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTLOW",
        "first_name": "MICHELLE",
        "middle_name": "LYN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-25",
        "last_updated": "2025-12-12",
        "certification_date": "2025-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1099356",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "74683",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "C-APN.0101005-C-NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corporate Health Dimensions Dba Goodyear Pharmacy Tyler
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• Psychiatric/Mental Health Nurse Practitioner in Tyler, TX
• Providers in Tyler, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.