Healthcare Provider Details

I. General information

NPI: 1073753018
Provider Name (Legal Business Name): LYDIA ELIZABETH EZZELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 HICKORY STREET SUITE 102
ABILENE TX
79601-2334
US

IV. Provider business mailing address

1850 HICKORY STREET SUITE 102
ABILENE TX
79601-2334
US

V. Phone/Fax

Practice location:
  • Phone: 325-677-2801
  • Fax: 325-677-9110
Mailing address:
  • Phone: 325-677-2801
  • Fax: 325-677-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number719378
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: