Provider Demographics
NPI:1467234179
Name:SHORTER, RONDA KAY (MSN, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:KAY
Last Name:SHORTER
Suffix:
Gender:F
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3681
Mailing Address - Country:US
Mailing Address - Phone:269-323-1954
Mailing Address - Fax:269-276-0201
Practice Address - Street 1:625 HARRISON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3681
Practice Address - Country:US
Practice Address - Phone:269-323-1954
Practice Address - Fax:269-276-0201
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704343974363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health