Healthcare Provider Details

I. General information

NPI: 1538089958
Provider Name (Legal Business Name): AMY MICHELLE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 56TH ST SW STE 4
WYOMING MI
49418-9494
US

IV. Provider business mailing address

555 STONEHENGE DR SW
GRANDVILLE MI
49418-3369
US

V. Phone/Fax

Practice location:
  • Phone: 616-560-5638
  • Fax:
Mailing address:
  • Phone: 616-275-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704235426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: