Healthcare Provider Details

I. General information

NPI: 1619381340
Provider Name (Legal Business Name): ALYSSA KATHRYNE EZELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 AIRPORT RD SW STE 210
HUNTSVILLE AL
35802-4304
US

IV. Provider business mailing address

610 AIRPORT RD SW STE 210
HUNTSVILLE AL
35802-4304
US

V. Phone/Fax

Practice location:
  • Phone: 256-883-0098
  • Fax: 256-883-0733
Mailing address:
  • Phone: 256-883-0098
  • Fax: 256-883-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number1-127404
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-127404
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: