Holly Marie Hendershot, APRN
Individual provider Active NPI Family Nurse Practitioner · Warren, MI
NPI 1083366397 · NPPES record last updated Nov 7, 2022
Key facts
- NPI
- 1083366397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 4704287330 (MI)
- Practice address
- 28800 Ryan Rd Ste 320
Warren, MI 48092-4272 - Phone
- (877) 906-9699
- Fax
- (866) 227-7418
- NPI assigned
- Jan 19, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Pure Psychiatry of Michigan PLLC
Behavioral Care Solutions for Adults and Seniors Inc
Practice addresses (Care Compare)
3031 Commerce Dr
Suite a
Fort Gratiot, MI 48059-4515
Phone (810) 292-0557
39465 W 14 Mile Rd
Novi, MI 48377-1600
Phone (877) 906-9699
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221114002792 | MI | Practitioner - Nurse Practitioner | 6406224906 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704287330 | MI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavioral Care Solutions for Adults and Seniors, Inc. | Family | Current |
Accepting new patients |
| Vpa PC | Current |
Accepting new patients | |
| Vpa PC | Current |
Accepting new patients | |
| Pure Psychiatry of Michigan PLLC | Current |
Accepting new patients | |
| Vpa PC | Current | Accepting new patients |
Locations
3031 Commerce Dr
Ste A
Fort Gratiot, MI 48059
Phone (810) 292-0557
39465 W 14 Mile Rd
Novi, MI 48377
Phone 24885939000
500 Kirts Blvd
Ste 200
Troy, MI 48084
Phone (248) 824-6060
28800 Ryan Rd
Ste 320
Warren, MI 48092
Phone (586) 582-0500
34841 Veterans Plz
Wayne, MI 48184
Phone (313) 292-7640
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704287330 | MI | |
| Family Nurse Practitioner | 363LF0000X | 4704287330 | MI | Yes |
Addresses
Primary practice location
28800 Ryan Rd Ste 320
Warren, MI 48092-4272
Mailing address
613 Brown St
Saint Clair, MI 48079-4891
Phone (810) 887-7858
Other practice location 1
2795 Edison Dr
Marysville, MI 48040-2068
Phone (810) 300-6100
Other providers in Warren, MI
- Heidi'S Counseling Services, PC
- Help Mate Home Care LLC
- Helping Hands Bless LLC
- Helpinghandscarellc
- Paula Christine Hemphill
- Courtney Hendon
- Matthew Hendrix
- Henr Y Ford Health System
- Henry Ford Health Eastwood Behavioral Health
- Henry Ford Health Macomb Oakland Hospital
All providers in Warren, MI · Family Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.