Brandon Omar Costilla

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

337342 Issued in TX

Practice address

2251 W Lingleville Rd Apt 24B
Stephenville, TX 76401-6008

Phone

(325) 330-2294

NPI assigned

Mar 29, 2019

Last updated

Mar 29, 2019By the provider in NPPES

Sex

Male

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": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553817600000",
    "number": "1992266126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 W LINGLEVILLE RD APT 24B",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764016008",
            "telephone_number": "325-330-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 W LINGLEVILLE RD APT 24B",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764016008",
            "telephone_number": "325-330-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTILLA",
        "first_name": "BRANDON",
        "middle_name": "OMAR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-29",
        "last_updated": "2019-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "TX",
            "license": "337342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Cooper, FNP-C
• Wayne Max Cooper, PTA
• Shelby Cornell-Price, PT
• Cornerstone Senior Services, Inc. (Goodtree Retirement Community)
• Peter Corta, P.A.
• Countryside Therapy Group Home Health, LLC
• Countryside Therapy Group, Inc
• County of Erath (Erath County EMS)
• Cowboy Capital Emergency Physicians
• Amelia Cox

• Licensed Vocational Nurse in Stephenville, TX
• Providers in Stephenville, TX by specialty
• Licensed Vocational Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2019; 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.