Healthcare Provider Details

I. General information

NPI: 1417872979
Provider Name (Legal Business Name): CASEY LYNN SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6499 SMITH RD
RAPID CITY MI
49676-9125
US

IV. Provider business mailing address

6499 SMITH RD
RAPID CITY MI
49676-9125
US

V. Phone/Fax

Practice location:
  • Phone: 231-350-1137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704354458
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: