Provider Demographics
NPI:1134465826
Name:LIGHT, KARI SUZANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:SUZANNE
Last Name:LIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5791
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:204 EVANS RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:NC
Practice Address - Zip Code:27844-9247
Practice Address - Country:US
Practice Address - Phone:252-586-5151
Practice Address - Fax:252-586-6932
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04245363AM0700X
PAMA054654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCE446AMedicare PIN