Provider Demographics
NPI:1710530571
Name:LIGHT, AMANDA K (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:LIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W SEVIER AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3770
Mailing Address - Country:US
Mailing Address - Phone:423-230-4660
Mailing Address - Fax:423-230-4669
Practice Address - Street 1:117 W SEVIER AVE STE 120
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3770
Practice Address - Country:US
Practice Address - Phone:423-230-4660
Practice Address - Fax:423-230-4669
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily