Provider Demographics
NPI:1942510847
Name:LIGHT, KIMBERLY (NP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
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 1:5801 W WADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5055
Mailing Address - Country:US
Mailing Address - Phone:432-699-2636
Mailing Address - Fax:432-699-4134
Practice Address - Street 1:5801 W WADLEY AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5055
Practice Address - Country:US
Practice Address - Phone:432-699-2636
Practice Address - Fax:432-699-4134
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686457363L00000X
TXAP119574363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner