Basic Information
| Provider Information | |||||||||
| NPI: | 1245628098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | ROSE-MEYER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCCOTTER | ||||||||
| OtherFirstName: | COURTNEY | ||||||||
| OtherMiddleName: | ROSE-MEYER | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.A. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5016 COOPERS LANDING DR | ||||||||
| Address2: | APT 3B | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490047647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695794152 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 363 FREMONT ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490173389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699696123 | ||||||||
| FaxNumber: | 2699696122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2015 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 5601007239 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.