Provider Demographics
NPI:1962559682
Name:EWALT, KARI JEAN (MS, MA)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:JEAN
Last Name:EWALT
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:MS
Other - First Name:KARI
Other - Middle Name:
Other - Last Name:AMEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-853-0803
Mailing Address - Fax:248-852-5859
Practice Address - Street 1:1701 SOUTH BLVD E STE 110
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6118
Practice Address - Country:US
Practice Address - Phone:248-853-0803
Practice Address - Fax:248-852-5859
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011398363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty