Healthcare Provider Details

I. General information

NPI: 1396673422
Provider Name (Legal Business Name): JADE COURTNEY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 PARK ST
NORTON SHORES MI
49444-3736
US

IV. Provider business mailing address

3535 PARK ST
NORTON SHORES MI
49444-3736
US

V. Phone/Fax

Practice location:
  • Phone: 231-875-6700
  • Fax:
Mailing address:
  • Phone: 231-875-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704382359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: