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General NPI Number Information
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NPI Number | 1962131979
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Entity Type | Organization
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Legal Business Name | DRIVE RIGHT, LLC
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 201 STATELINE RD W STE 5A
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1600
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Country | US
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Telephone | 662-253-8959
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Fax | 662-470-6918
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Provider Business Mailing Address
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Address Line | 3715 CYPRESS PLANTATION DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7640
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Country | US
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Telephone | 626-253-8959
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Fax | 662-470-6918
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Authorized Official
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Title or Position | NP
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Name | BONNIE ELLZEY
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Credential | FNP
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Telephone | 662-253-8959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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