Provider Demographics
NPI:1154841328
Name:PERINO, KELI MARIE (RDN)
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:MARIE
Last Name:PERINO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 E FORT LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1312
Mailing Address - Country:US
Mailing Address - Phone:520-490-8452
Mailing Address - Fax:
Practice Address - Street 1:3955 EAGLE CREEK PKWY STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4692
Practice Address - Country:US
Practice Address - Phone:888-998-7337
Practice Address - Fax:844-465-6341
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-2384133V00000X
OK2806133V00000X
KY269529133V00000X
IN37003311A133V00000X
NMLD-1561133V00000X
PADN007413133V00000X
FLND10374133V00000X
CA86068880133V00000X
ORLD-D-10213594133V00000X
WI3783133V00000X
NCL006366133V00000X
MO2021031912133V00000X
AZ8606880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered