Provider Demographics
NPI:1427924745
Name:EZELLE, MATTHEW SEAN (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SEAN
Last Name:EZELLE
Suffix:
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 FOXFIRE CIR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-3168
Mailing Address - Country:US
Mailing Address - Phone:865-755-7877
Mailing Address - Fax:
Practice Address - Street 1:1549 FOXFIRE CIR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-3168
Practice Address - Country:US
Practice Address - Phone:865-755-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40019363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily