Provider Demographics
NPI:1801690870
Name:SMITH, CANDY LYNN (NP)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 S FERRIS RD
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:MI
Mailing Address - Zip Code:48889-9719
Mailing Address - Country:US
Mailing Address - Phone:989-763-6601
Mailing Address - Fax:
Practice Address - Street 1:2480 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-775-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704169609363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health