KELLY GRANT EZZELL, ARNP — NPI 1760906184 (Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) in WILMINGTON, NC)

CMS-1500 Box 24J / 33a • NPI

1760906184

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LP0200X (CMS 50)

Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)

Box 32 Service Location & ZIP+4

1501 DOCK ST, WILMINGTON, NC, 28401-4936

✓ 9-Digit EDI 837 ZIP+4 (28401-4936)

Practice Phone & Referral Fax

(910) 254-9898

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1760906184 (KELLY GRANT EZZELL, ARNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1760906184` (NPI-1 Individual Practitioner)
Provider / Legal Name	KELLY GRANT EZZELL, ARNP
Plain-English Specialty	Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) NUCC Code: `363LP0200X` (Nurse Practitioner, Pediatrics)
Certifying / Licensing Body	American Board of Pediatrics (ABP)
Practice Location Address	1501 DOCK ST, WILMINGTON, NC, 28401-4936
Practice Telephone / Fax	Tel: (910) 254-9898
Administrative Mailing Address	1501 DOCK ST, WILMINGTON, NC, 28401-4936
Enumeration & Last Sync	Enumerated: 2017-07-27 \| CMS Record Updated: 2026-07-10

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1501 DOCK ST, WILMINGTON, NC, 28401-4936

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Plain-English Taxonomy & CMS Crosswalk (363LP0200X)

What Does Taxonomy Code 363LP0200X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LP0200X translates to:
"Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: American Board of Pediatrics (ABP)
Clinical Scope: Newborn jaundice screening, routine childhood vaccinations, developmental milestones, pediatric fevers, ear infections, asthma, or acute gastroenteritis.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KELLY GRANT EZZELL, ARNP)

Typical CPT / Diagnostic Procedures:

Comprehensive Well-Child Developmental & Growth Visits (CPT 99381–99394)
Childhood Immunization Administration (Rotavirus, MMR, DTaP, HPV, PCV)
Neonatal Bilirubin & Jaundice Transcutaneous/Serum Screening
Rapid Streptococcal, RSV & Influenza Point-of-Care Diagnostics
Pediatric Asthma Nebulization & Spirometry Evaluation

Common Therapeutic Classes:

Amoxicillin / Amoxicillin-Clavulanate (Pediatric Otitis Media & Sinusitis)
WHO Low-Osmolarity Oral Rehydration Salts (ORS) & Zinc Sulfate
Albuterol Sulfate Inhalers & Fluticasone Pediatric Inhalers
Weight-Based Acetaminophen & Ibuprofen Antipyretic Suspensions

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363LP0200X` — Nurse Practitioner, Pediatrics Plain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)	State: NC \| License: `319192` \| Primary: Yes (Primary)
`2088P0231X` — Urology, Pediatric Urology Plain English: Board-Certified Urologist (Urinary Tract, Kidney Stone & Prostate Surgeon)	State: FL \| License: `ARNP9384638` \| Primary: Secondary
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: FL \| License: `ARNP9384638` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

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KELLY GRANT EZZELL, ARNP (NPI #1760906184)