Kelly Jean Perez, REGISTERED DIETITIAN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

L003552 Issued in NC

Practice address

4076 Neely Rd
Ft. Wainwright, AK 99703

Phone

(254) 495-5506

NPI assigned

Nov 13, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524009600000",
    "number": "1053565366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 LILY DR APT 1",
            "city": "FT WAINWRIGHT",
            "state": "AK",
            "postal_code": "997031531",
            "telephone_number": "254-495-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4076 NEELY RD",
            "city": "FT. WAINWRIGHT",
            "state": "AK",
            "postal_code": "99703",
            "telephone_number": "254-495-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "REGISTERED DIETITIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-13",
        "last_updated": "2018-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L003552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Optical Center
• Glenn Parker
• David Patefield, DPT
• Suhani Patel, D.O.
• Lorna Delrico Peay, NURSE
• Omar Perez, CRNA
• Linda M Perkins
• Grant Dee Petersen, D.D.S.
• Aaron Siglow Pfaff, DDS
• Ryan K Phillips, D,O.

• Registered Dietitian in Ft. Wainwright, AK
• Providers in Ft. Wainwright, AK by specialty
• Registered Dietitian in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.