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Melissa Ann Ezelle

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

6414 Hwy 98 W, Suite 120, Hattiesburg, MS 39402-3940

PECOS Enrollment

This provider is enrolled in PECOS as MELISSA EZELLE.

Based on the most recent information from CMS, provider Melissa Ann Ezelle is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1851924013
Provider Type
Individual
Full Name
Ezelle, Melissa Ann
Title
Mrs.

Gender
Female
Sole Proprietor
Yes
Enumeration Date
2/17/2020
Last Updated
10/8/2021

Contact Information

Practice Location

6414 Hwy 98 W, Suite 120, Hattiesburg, MS 39402-3940

(601) 296-2833

Unlisted Fax

Mailing Location

23 Clinton Rd, Hattiesburg, MS 39402-9709

(601) 519-2703

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 904880 Mississippi
Code 163W00000X	Description Registered Nurse Nursing Service Providers	License R871458 Mississippi

Melissa Ann Ezelle

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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Delancey, Melinda Bennett

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