Provider Demographics
NPI:1902235849
Name:COSTON, AMBER DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:COSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3539
Mailing Address - Country:US
Mailing Address - Phone:210-614-5539
Mailing Address - Fax:210-614-5548
Practice Address - Street 1:5430 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 508
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3539
Practice Address - Country:US
Practice Address - Phone:210-614-5539
Practice Address - Fax:210-614-5548
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TXPA08687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical