Healthcare Provider Details

I. General information

NPI: 1881315059
Provider Name (Legal Business Name): MICHAELA GARRISON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 HAWTHORNE AVE
SUMMERVILLE SC
29483-5523
US

IV. Provider business mailing address

170 MEETING ST
CHARLESTON SC
29401-3153
US

V. Phone/Fax

Practice location:
  • Phone: 406-207-7337
  • Fax: 636-206-8531
Mailing address:
  • Phone: 406-207-7337
  • Fax: 636-206-8531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26604
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number242915
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: