Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mykala Paris Supplice, PAC

Individual provider Physician Assistant · NPI 1790209070

Mykala Paris Supplice, PAC is a Physician Assistant in Grand Rapids, Michigan. Qualified in 2023, 3 years ago. Practices with Spectrum Health Primary Care Partners, a 2,303-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
3
Licensed in
MI
In the registry since
2017
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

1900 Wealthy St SE Ste 300
Grand Rapids, MI 49506-2969
Phone: (616) 774-8345
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601011723 (MI)

Record details

NPI number1790209070
Entity typeIndividual (Type 1)
GenderFemale
Credentials PAC
Sole proprietorNo
NPI enumeratedJuly 28, 2017
Last updated in NPPESMarch 25, 2024
Certification dateMarch 25, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Spectrum Health Primary Care Partners — 2303 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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