Healthcare Provider Details

I. General information

NPI: 1639018633
Provider Name (Legal Business Name): KIERRA CORBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 WATSON BLVD
WARNER ROBINS GA
31093-3634
US

IV. Provider business mailing address

PO BOX 117598
ATLANTA GA
30368-7598
US

V. Phone/Fax

Practice location:
  • Phone: 478-918-0770
  • Fax: 478-918-0771
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-442-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP273002
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: