Provider Demographics
NPI:1962131979
Name:DRIVE RIGHT, LLC
Entity type:Organization
Organization Name:DRIVE RIGHT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLZEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-253-8959
Mailing Address - Street 1:3715 CYPRESS PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7640
Mailing Address - Country:US
Mailing Address - Phone:626-253-8959
Mailing Address - Fax:662-470-6918
Practice Address - Street 1:201 STATELINE RD W STE 5A
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1600
Practice Address - Country:US
Practice Address - Phone:662-253-8959
Practice Address - Fax:662-470-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS904198OtherMS BOARD OF NURSING
MS1972129609OtherNURSE PRAC INDIVIDUAL NPI
MS14740OtherMS BOARD OF MEDICINE MEDICAL LICENSE
1922003037OtherMD PROVIDER NPI