Provider Demographics
NPI:1093282766
Name:EZELL, DORINDA VERNITA (FNP-C)
Entity Type:Individual
Prefix:
First Name:DORINDA
Middle Name:VERNITA
Last Name:EZELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-0035
Mailing Address - Country:US
Mailing Address - Phone:251-454-8728
Mailing Address - Fax:
Practice Address - Street 1:652 BELLEMEADE AVE NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3102
Practice Address - Country:US
Practice Address - Phone:470-846-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106811363LF0000X
DC1019425363LF0000X
CA95010909363LF0000X
FLAPRN11001517363LF0000X
LA202043363LF0000X
MN6309363LF0000X
NY346118363LF0000X
WAAP61418514363LF0000X
CT12.011309363LF0000X
PASP019805363LF0000X
MI4704351002363LF0000X
GARN284643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F10180978OtherFAMILY NURSE PRACTITIONER