Provider Demographics
NPI:1265844039
Name:LIGHT, KERI (AUD)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:LIGHT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 OSBORNE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-2326
Mailing Address - Country:US
Mailing Address - Phone:276-669-6331
Mailing Address - Fax:276-669-2950
Practice Address - Street 1:2603 OSBORNE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-2326
Practice Address - Country:US
Practice Address - Phone:276-669-6331
Practice Address - Fax:276-669-2950
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001554231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist