Provider Demographics
NPI:1508581679
Name:SHIELDS, KELI M (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:KELI
Middle Name:M
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ZION CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9688
Mailing Address - Country:US
Mailing Address - Phone:845-532-0065
Mailing Address - Fax:
Practice Address - Street 1:4600 MERCY LN
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-3070
Practice Address - Country:US
Practice Address - Phone:479-347-3721
Practice Address - Fax:479-338-4629
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2641133V00000X
86211365133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered