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

Nicole Smith, PA

Individual provider Physician Assistant · NPI 1053941674

Nicole Smith, PA is a Physician Assistant in Bangor, Michigan. Qualified in 2019, 7 years ago. Practices with Bronson Lakeview Hospital, a 72-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
7
Licensed in
MI
In the registry since
2020
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

520 Railroad St
Bangor, MI 49013-1490
Phone: (269) 427-5811
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601009812 (MI)

Record details

NPI number1053941674
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJanuary 23, 2020
Last updated in NPPESNovember 11, 2024
Certification dateNovember 11, 2024
Mailing address601 John Street, Box 42, Kalamazoo, MI 49007

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Bronson Lakeview Hospital — 72 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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