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

Jaclyn Riley

Individual provider Nurse Practitioner · NPI 1063000545

Jaclyn Riley is a Nurse Practitioner in Canton, Michigan. Qualified in 2019, 7 years ago. Practices with Beaumont Medical Group- Specialty Services, a 858-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
7
Licensed in
MI
In the registry since
2021

Practice location Address checks out

2050 N Haggerty Rd Ste 200
Canton, MI 48187-3796
Phone: (313) 550-3353
Show map & directions

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

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 4704347010 (MI)

Record details

NPI number1063000545
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 9, 2021
Last updated in NPPESSeptember 29, 2023
Certification dateSeptember 29, 2023
Mailing address1083 Beaconsfield Ave, Grosse Pointe Park, MI 48230-1346

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Beaumont Medical Group- Specialty Services — 858 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

Other providers in Canton