Provider Demographics
NPI:1720608698
Name:LIGHTNER, TAYLOR W (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:W
Last Name:LIGHTNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 JACKSON RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:VA
Mailing Address - Zip Code:24465-2700
Mailing Address - Country:US
Mailing Address - Phone:770-833-6774
Mailing Address - Fax:
Practice Address - Street 1:120 JACKSON RIVER RD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:VA
Practice Address - Zip Code:24465-2416
Practice Address - Country:US
Practice Address - Phone:540-468-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-173585163W00000X
VA0024182884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse