Provider Demographics
NPI:1144965898
Name:CORBIN, ANGELA M (PMHNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:CORBIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S PEARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-3245
Mailing Address - Country:US
Mailing Address - Phone:662-719-7457
Mailing Address - Fax:662-368-6324
Practice Address - Street 1:109 S PEARMAN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-3245
Practice Address - Country:US
Practice Address - Phone:662-368-6291
Practice Address - Fax:662-368-6324
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905342363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health