Provider Demographics
NPI:1982806758
Name:KOLLI, VEENA (PMHNP, APRN- CNP)
Entity type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:KOLLI
Suffix:
Gender:F
Credentials:PMHNP, APRN- CNP
Other - Prefix:
Other - First Name:VEENA
Other - Middle Name:
Other - Last Name:GOGINENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1145 W I 240 SERVICE RD STE F100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2134
Mailing Address - Country:US
Mailing Address - Phone:405-259-2233
Mailing Address - Fax:
Practice Address - Street 1:1145 W I 240 SERVICE RD STE F100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2134
Practice Address - Country:US
Practice Address - Phone:239-410-0332
Practice Address - Fax:319-272-2107
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-08-30
Deactivation Date:2013-10-10
Deactivation Code:
Reactivation Date:2024-08-22
Provider Licenses
StateLicense IDTaxonomies
OK2024005252363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAFK0246240OtherNUMBER