Provider Demographics
NPI:1508581679
Name:SHIELDS, KELI M (PLD)
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:M
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S HORSEBARN RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8184
Mailing Address - Country:US
Mailing Address - Phone:479-338-4338
Mailing Address - Fax:
Practice Address - Street 1:1001 S HORSEBARN RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8184
Practice Address - Country:US
Practice Address - Phone:479-338-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPLD310133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered