Healthcare Provider Details

I. General information

NPI: 1053081638
Provider Name (Legal Business Name): KALLI KERR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 W SAGINAW HWY
LANSING MI
48917-1106
US

IV. Provider business mailing address

6430 W SAGINAW HWY
LANSING MI
48917-1106
US

V. Phone/Fax

Practice location:
  • Phone: 517-886-1323
  • Fax:
Mailing address:
  • Phone: 517-886-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303039345
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: