Individual
BONNIE ELIZABETH ELLZEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
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
(901) 674-4161
(662) 470-6918
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
902486
MS
207Q00000X
Family Medicine Physician
904198
MS
207QA0505X
Adult Medicine Physician
904198
MS
363LF0000X
Family Nurse Practitioner
Primary
904198
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30309
TN BOARD OF NURSING
TN
01
—
904198
MS BOARD OF NURSING
MS
Enumeration date
06/18/2020
Last updated
06/24/2022
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