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

Kimberly Mattina

Individual provider Acute Care Nurse Practitioner · NPI 1104231083

Kimberly Mattina is a Nurse Practitioner in Southfield, Michigan. Qualified in 2019, 7 years ago. Practices with Henry Ford Health System, a 2,540-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
7
Licensed in
MI
In the registry since
2014
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Practice location Address checks out

26206 W 12 Mile Rd Ste 105
Southfield, MI 48034-1799
Phone: (248) 200-3715
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 53156 Cripple Creek Dr, Chesterfield, MI 48047-5960 — (248) 495-6857

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 4704306684 (MI)

Record details

NPI number1104231083
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJune 30, 2014
Last updated in NPPESSeptember 7, 2023
Certification dateSeptember 7, 2023
Mailing address1 Ford Pl Ste 3a, Detroit, MI 48202-3450

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 Henry Ford Health System — 2540 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Southfield