Healthcare Provider Details

I. General information

NPI: 1144835695
Provider Name (Legal Business Name): KELSEY VEARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BREEZEWOOD AVE
FAYETTEVILLE NC
28303-5408
US

IV. Provider business mailing address

2800 BREEZEWOOD AVE
FAYETTEVILLE NC
28303-5408
US

V. Phone/Fax

Practice location:
  • Phone: 910-687-4099
  • Fax:
Mailing address:
  • Phone: 254-833-3700
  • Fax: 254-442-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2832578
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-134981
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberA2247
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: