Healthcare Provider Details

I. General information

NPI: 1467377754
Provider Name (Legal Business Name): JESSICA EASTERBROOK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 3 MILE RD NW STE 200
GRAND RAPIDS MI
49544-8224
US

IV. Provider business mailing address

101 N 3RD ST UNIT 508
GRAND HAVEN MI
49417-1402
US

V. Phone/Fax

Practice location:
  • Phone: 616-647-3770
  • Fax:
Mailing address:
  • Phone: 937-701-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: