Provider Demographics
NPI:1033900626
Name:KELLY, VERONICA ADRIAN (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:ADRIAN
Last Name:KELLY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MRS
Other - First Name:VERONICA
Other - Middle Name:ADRIAN
Other - Last Name:BECKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:758 N CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:OK
Mailing Address - Zip Code:73030-6604
Mailing Address - Country:US
Mailing Address - Phone:817-308-7708
Mailing Address - Fax:
Practice Address - Street 1:758 N CHICKASAW TRL
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:OK
Practice Address - Zip Code:73030-6604
Practice Address - Country:US
Practice Address - Phone:817-308-7708
Practice Address - Fax:817-308-7708
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK220653363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health