Provider Demographics
NPI:1275367518
Name:LONGORIA, KALI MICHELLE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:MICHELLE
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:KALI
Other - Middle Name:MICHELLE
Other - Last Name:KAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2591 N ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1171
Mailing Address - Country:US
Mailing Address - Phone:517-610-8365
Mailing Address - Fax:
Practice Address - Street 1:2591 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1171
Practice Address - Country:US
Practice Address - Phone:517-610-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294647363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics