Provider Demographics
NPI:1619381340
Name:EZELL, ALYSSA KATHRYNE (CRNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KATHRYNE
Last Name:EZELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SHONEY DR SW STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5309
Mailing Address - Country:US
Mailing Address - Phone:256-883-0098
Mailing Address - Fax:256-883-0733
Practice Address - Street 1:809 SHONEY DR SW
Practice Address - Street 2:SUITE 202
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5308
Practice Address - Country:US
Practice Address - Phone:256-883-0098
Practice Address - Fax:256-883-0733
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127404163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology