Healthcare Provider Details

I. General information

NPI: 1942099429
Provider Name (Legal Business Name): MICAH METTS CORBIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 SUNSET BLVD
WEST COLUMBIA SC
29169-3428
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-359-8855
  • Fax: 803-794-6480
Mailing address:
  • Phone: 803-604-0066
  • Fax: 803-604-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number30382
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: