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General NPI Number Information
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NPI Number | 1184429284
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL SOUTHEAST, LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 7165 SWINNEA RD STE 2
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6360
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Country | US
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Telephone | 662-922-2023
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Fax |
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Provider Business Mailing Address
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Address Line | 384 GOODMAN RD E # 127
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9522
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Country | US
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Telephone | 662-922-2023
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Fax | 662-246-2034
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | CHASSITY GREER
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Credential | DNP, APRN, NP-C
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Telephone | 662-922-2023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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