Individual provider Active NPI

Brooke Criddle Light, MD

  • Pediatric Critical Care Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1598405714
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
45399 Issued in OK
Practice address
1200 Childrens Ave
Oklahoma City, OK 73104-4637
Phone
(405) 271-5437
NPI assigned
Mar 29, 2022
Last updated
May 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X LL88189 SC
Pediatrics Physician 208000000X 45399 OK
Pediatric Critical Care Medicine Physician 2080P0203X 45399 OK Primary

Addresses

Primary practice location

1200 Childrens Ave
Oklahoma City, OK 73104-4637

Mailing address

1200 Childrens Ave
Oklahoma City, OK 73104-4637
Phone (405) 271-5437

Other practice location 1

701 Grove Rd
Greenville, SC 29605-4210
Phone (864) 455-7895

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220720002266 SC Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 8820479983

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
LL88189SCMDPediatrics Physician
45399OKMDPediatric Critical Care Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1598405714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CHILDRENS AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731044637",
            "telephone_number": "405-271-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CHILDRENS AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731044637",
            "telephone_number": "405-271-5437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296054210",
            "country_code": "US",
            "telephone_number": "864-455-7895",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "BROOKE",
        "middle_name": "CRIDDLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-29",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "LL88189",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "45399",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "OK",
            "license": "45399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.