Healthcare Provider Details

I. General information

NPI: 1477364495
Provider Name (Legal Business Name): KATERI ROSE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W GRAND RIVER AVE STE 4
OKEMOS MI
48864-2394
US

IV. Provider business mailing address

5668 OKEMOS RD
HASLETT MI
48840-9539
US

V. Phone/Fax

Practice location:
  • Phone: 517-381-6880
  • Fax:
Mailing address:
  • Phone: 517-214-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704360504
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: