| Drive Right | |
|
201 Stateline Rd W Ste 5a Southaven MS 38671-1600 | |
| (662) 253-8959 | |
| (662) 470-6918 |
| Full Name | Drive Right |
|---|---|
| Speciality | Family Medicine |
| Location | 201 Stateline Rd W Ste 5a, Southaven, Mississippi |
| Authorized Official Name and Position | Bonnie Ellzey (NP) |
| Authorized Official Contact | 6622538959 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Drive Right 3715 Cypress Plantation Dr Olive Branch MS 38654-7640 Ph: (626) 253-8959 | Drive Right 201 Stateline Rd W Ste 5a Southaven MS 38671-1600 Ph: (662) 253-8959 |
| NPI Number | 1962131979 |
|---|---|
| Provider Enumeration Date | 06/06/2022 |
| Last Update Date | 07/01/2022 |
| Medicare PECOS PAC ID | 9032589932 |
|---|---|
| Medicare Enrollment ID | O20230111001180 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962131979 | NPI | - | NPPES |
| 904198 | Other | MS | MS BOARD OF NURSING |
| 1972129609 | Other | MS | NURSE PRAC INDIVIDUAL NPI |
| 14740 | Other | MS | MS BOARD OF MEDICINE MEDICAL LICENSE |
| 1922003037 | Other | MD PROVIDER NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | Bonnie Ellzey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972129609 PECOS PAC ID: 6709291206 Enrollment ID: I20210216000403 |
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