BONNIE ELIZABETH ELLZEY FNP-C NPI 1972129609

NPI Information

NPI: 1972129609
Provider Name: BONNIE ELIZABETH ELLZEY, FNP-C
Classification: Nurse Practitioner - 363LF0000X
Specialization: Family
Entity Type: Individual
PECOS Registration: Yes
Address: 201 STATELINE RD W STE 5A
SOUTHAVEN, MS
ZIP 38671
Phone: (662) 253-8959

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NPI Details

Bonnie Elizabeth Ellzey, FNP-C is a family nurse practitioner in Southaven, MS with 5 years of experience. Bonnie Elizabeth Ellzey, FNP-C NPI is 1972129609. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

201 STATELINE RD W STE 5A
SOUTHAVEN, MS
ZIP 38671-600
Phone: (662) 253-8959
Fax: (662) 470-6918

The NPI 1972129609 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/18/2020 and was last updated on 6/24/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WM0705X	Registered Nurse	Medical-Surgical	902486	MISSISSIPPI	No
2	207Q00000X	Family Medicine		904198	MISSISSIPPI	No
3	207QA0505X	Family Medicine	Adult Medicine	904198	MISSISSIPPI	No
4	363LF0000X	Nurse Practitioner	Family	904198	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	904198	OTHER	MISSISSIPPI	MS BOARD OF NURSING
2	30309	OTHER	TENNESSEE	TN BOARD OF NURSING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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