Individual
MARY ANN LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
796 RIDGEWAY AVE, SIGNAL MOUNTAIN, TN 37377-3067
(423) 886-3269
Mailing address
PO BOX 772, WOONSOCKET, RI 02895-0784
(401) 770-5779
(401) 652-9787
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-052430
AL
363LF0000X
Family Nurse Practitioner
12784
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051530066
BC FORT PAYNE
AL
01
—
051530068
BC BOAZ
AL
05
—
891010020
—
AL
05
—
891010030
—
AL
Enumeration date
08/01/2006
Last updated
06/28/2013
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