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NPI Code Detail

MEDICARE: SHARON ELAINE EZELL NP

MEDICARE: SHARON ELAINE EZELL NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner15918TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063799583
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHARON ELAINE EZELL NP
Provider Business Mailing Address
First Line : 350 W WOODROW WILSON AVE STE 1600
Second Line :
City : JACKSON
State : MS
Zip : 39213-7627
Country : US
Telephone Number : 601-815-6886
Fax Number :
Provider Business Practice Location Address
First Line : 2500 N STATE ST
Second Line :
City : JACKSON
State : MS
Zip : 39216-4500
Country : US
Telephone Number : 601-815-6886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2011
Last Update Date : 12/21/2025

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Directions to “ SHARON ELAINE EZELL NP” Practice Location

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