Provider Demographics
NPI:1922726512
Name:VELASQUEZ, KELLY LYNN (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:PMHNP
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Mailing Address - Street 1:1651 WOOD LANE DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7355
Mailing Address - Country:US
Mailing Address - Phone:901-568-8843
Mailing Address - Fax:
Practice Address - Street 1:6858 SWINNEA RD BLDG 3B
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9493
Practice Address - Country:US
Practice Address - Phone:662-420-2418
Practice Address - Fax:855-529-1633
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2025-01-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS905496363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health