Provider Demographics
NPI:1548148554
Name:DONELSON, KALI RENEE (RDN)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:RENEE
Last Name:DONELSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KALI
Other - Middle Name:RENEE
Other - Last Name:GUMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21530 CARLETON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-3059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21530 CARLETON PLACE DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-3059
Practice Address - Country:US
Practice Address - Phone:586-354-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86093923133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered