Provider Demographics
NPI:1013387083
Name:LIGHT, JENNIFER (DNP, APRN, CNM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:LIGHT
Suffix:
Gender:F
Credentials:DNP, APRN, CNM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1602 ROCK PRAIRIE RD STE 3400
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5992
Mailing Address - Country:US
Mailing Address - Phone:979-693-0737
Mailing Address - Fax:
Practice Address - Street 1:1602 ROCK PRAIRIE RD STE 3400
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5992
Practice Address - Country:US
Practice Address - Phone:979-693-0737
Practice Address - Fax:877-601-5854
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129212367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife