Healthcare Provider Details

I. General information

NPI: 1659298594
Provider Name (Legal Business Name): TAYLOR SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3267 N EVERGREEN DR NE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

6450 ESTATE DR SW
BYRON CENTER MI
49315-9617
US

V. Phone/Fax

Practice location:
  • Phone: 616-217-3632
  • Fax:
Mailing address:
  • Phone: 616-217-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4704358825
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: