Provider Demographics
NPI:1053081638
Name:KERR, KALLI
Entity Type:Individual
Prefix:
First Name:KALLI
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 W SAGINAW HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1106
Mailing Address - Country:US
Mailing Address - Phone:517-886-1323
Mailing Address - Fax:
Practice Address - Street 1:6430 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1106
Practice Address - Country:US
Practice Address - Phone:517-886-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
MI5303039345183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist