Healthcare Provider Details

I. General information

NPI: 1396297115
Provider Name (Legal Business Name): NADIA MARIE KIMBLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 MACK AVE
DETROIT MI
48207-2302
US

IV. Provider business mailing address

6309 MACK AVE
DETROIT MI
48207-2302
US

V. Phone/Fax

Practice location:
  • Phone: 313-921-4700
  • Fax:
Mailing address:
  • Phone: 313-921-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703112661
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704410597
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704410597
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: