Ezzell, Kelly Grant

Ezzell, Kelly Grant is an individual health care provider with primary practice located at 1501 Dock St , Wilmington NC 28401-4936. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatric Urology, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Ezzell, Kelly Grant can be contacted via phone (910) 254-9898.

Contact Information

Primary practice address
1501 Dock St Wilmington NC 28401-4936
Phone: (910) 254-9898
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Urology 2088P0231X ARNP9384638 Florida
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 319192 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X ARNP9384638 Florida

Profile Details

NPI number 1760906184
LBN Legal business name Ezzell, Kelly Grant
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2017
Last updated Oct 29th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760906184 NPPES
Florida MEDICAID 022054500

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