Organization
DRIVE RIGHT, LLC
Active
Other names
Drive Right
Organization subpart
No
Provider details
NPI number
Authorized official
BONNIE ELLZEY FNP (NP)
(662) 253-8959
Entity
Organization
Contact information
Practice address
201 STATELINE RD W STE 5A, SOUTHAVEN, MS 38671-1600
(662) 253-8959
(662) 470-6918
Mailing address
3715 CYPRESS PLANTATION DR, OLIVE BRANCH, MS 38654-7640
(626) 253-8959
(662) 470-6918
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14740
MS BOARD OF MEDICINE MEDICAL LICENSE
MS
01
—
1922003037
MD PROVIDER NPI
—
01
—
1972129609
NURSE PRAC INDIVIDUAL NPI
MS
01
—
904198
MS BOARD OF NURSING
MS
Enumeration date
06/06/2022
Last updated
07/01/2022
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