Provider Demographics
NPI:1073753018
Name:EZZELL, LYDIA ELIZABETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:ELIZABETH
Last Name:EZZELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1850 HICKORY STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2334
Mailing Address - Country:US
Mailing Address - Phone:325-677-2801
Mailing Address - Fax:325-677-9110
Practice Address - Street 1:1850 HICKORY STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2334
Practice Address - Country:US
Practice Address - Phone:325-677-2801
Practice Address - Fax:325-677-9110
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX719378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8096NCOtherBCBS
TX207986502Medicaid