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

Holly S Moore

Individual provider Adult Health Nurse Practitioner · NPI 1649616525

Holly S Moore is a Nurse Practitioner in Detroit, Michigan. Qualified in 2012, 14 years ago. Practices with Beaumont Medical Group- Specialty Services, a 858-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
14
Licensed in
MI
In the registry since
2013
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

5200 Anthony Wayne Dr Ste 115
Detroit, MI 48202-3945
Phone: (313) 577-5041
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 4704222396 (MI)

Record details

NPI number1649616525
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 17, 2013
Last updated in NPPESMay 17, 2013

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Beaumont Medical Group- Specialty Services — 858 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Detroit