Kelly Grant Ezzell, ARNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

319192 Issued in NC

Practice address

1501 Dock St
Wilmington, NC 28401-4936

Phone

(910) 254-9898

NPI assigned

Jul 27, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Medical University of South Carolina College of Medicine, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kezzell532013@direct.ecuhealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• East Carolina University

  dba ECU Physicians

  • Family Medicine Physician
  • Greenville, NC
  • NPI 1972551919
  Medicare reassignment NPD
• East Carolina University

  • Internal Medicine Physician
  • Greenville, NC
  • NPI 1043260474
  NPD
• The Carousel Center, Inc.

  • Medical Specialty Clinic/Center
  • Wilmington, NC
  • NPI 1063696375
  NPD (past)
• Triangle Hearing Services, P.a.

  • Audiologist-Hearing Aid Fitter
  • Cary, NC
  • NPI 1982916367
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783641600000",
    "number": "1760906184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 DOCK ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014936",
            "telephone_number": "910-254-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 DOCK ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014936",
            "telephone_number": "910-254-9898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2303 Executive Cir",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278343749",
            "country_code": "US",
            "telephone_number": "252-744-8334",
            "fax_number": "252-744-8335",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "545 Michael Martin Rd",
            "address_purpose": "LOCATION",
            "city": "Mount Olive",
            "state": "NC",
            "postal_code": "283651131",
            "country_code": "US",
            "telephone_number": "252-737-3330",
            "fax_number": "252-737-3331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EZZELL",
        "first_name": "KELLY",
        "middle_name": "GRANT",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-27",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "319192",
            "primary": true
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "FL",
            "license": "ARNP9384638",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9384638",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022054500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eyecarecenter OD PA
• Eyecarecenter OD PA
• Eyemart Express LLC
• Eyemart Express LTD
• Yazhini Ezhilvendan
• Windy J Ezzell, MA, LPC
• Elizabeth A Fagan, NURSE PRACTIONER
• Jordan Fagan
• Sean Fahle, PHARM.D.
• Lynn Carver Fahning

• Pediatric Nurse Practitioner in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Pediatric Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.