Provider Demographics
NPI:1164707931
Name:EUPERIO, KELLY (RD, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:EUPERIO
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9190
Mailing Address - Country:US
Mailing Address - Phone:719-930-4897
Mailing Address - Fax:
Practice Address - Street 1:569 CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9190
Practice Address - Country:US
Practice Address - Phone:719-930-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
COL-97868174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered