Elizabeth Revere McMahan, AGPCNP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

4704318459 Issued in MI

Practice address

2799 W Grand Blvd
Detroit, MI 48202-2608

Phone

(313) 916-2588

NPI assigned

Dec 29, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michigan Lung and Critical Care Specialists, PC

  • Pulmonary Disease Physician
  • Grand Blanc, MI
  • NPI 1013948686
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782086400000",
    "number": "1013786128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9450 S SAGINAW RD STE E",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398206",
            "telephone_number": "810-695-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-2588"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9450 S Saginaw Rd Ste E",
            "address_purpose": "LOCATION",
            "city": "Grand Blanc",
            "state": "MI",
            "postal_code": "484398206",
            "country_code": "US",
            "telephone_number": "810-695-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4000 Highland Rd Ste 130",
            "address_purpose": "LOCATION",
            "city": "Waterford",
            "state": "MI",
            "postal_code": "483282168",
            "country_code": "US",
            "telephone_number": "248-681-0455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCMAHAN",
        "first_name": "ELIZABETH",
        "middle_name": "REVERE",
        "name_prefix": "Mrs.",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-29",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704318459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Ann McLear, AU.D.
• Beth McLellan
• Kalisha McLendon, DDS
• Kailyn McLeod
• MCM Health Services
• Brett Alan McMahon, FNP-BC
• Colin Jantz McMahon, MD
• Autumn Rose McManamon, LCGC
• Daniel Terence McManus, RN
• Julia McMath, BSN,RN

• Adult Health Nurse Practitioner in Detroit, MI
• Providers in Detroit, MI by specialty
• Adult Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.