Healthcare Provider Details

I. General information

NPI: 1992696140
Provider Name (Legal Business Name): BAILEY WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MICHIGAN ST NE STE 3100
GRAND RAPIDS MI
49503-2563
US

IV. Provider business mailing address

1305 AIRFIELD LN
MIDLAND MI
48642-4791
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-9800
  • Fax:
Mailing address:
  • Phone: 989-330-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: