Healthcare Provider Details

I. General information

NPI: 1245628098
Provider Name (Legal Business Name): COURTNEY ROSE-MEYER SMITH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY ROSE-MEYER MCCOTTER P.A.

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14755 215TH AVE
BIG RAPIDS MI
49307-9224
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007239
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: