Active NPI
Carole S Light, PND
- Clinical Psychologist
- Scaly Mountain, NC
National Provider Identifier
1639288517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1604
- Practice address
- 318 Lakeside Rd
Scaly Mountain, NC 28775-0099 - Phone
- (828) 526-9769
- Fax
- (828) 526-8719
- NPI assigned
- Aug 30, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1604 | NC | Primary |
| Clinical Psychologist | 103TC0700X | 297 | GA |
Addresses
Primary practice location
318 Lakeside Rd
Scaly Mountain, NC 28775-0099
Mailing address
PO Box 99
318 Lakeside Rd
Scaly Mountain, NC 28775-0099
Phone (828) 526-9769
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1163W | Other | NC | BCBS NC |
Other names 1
- Mrs. Carole Light Redmountain
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 297 | GA | MD | Clinical Psychologist |
| 1604 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639288517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 99",
"address_2": "318 LAKESIDE RD",
"city": "SCALY MOUNTAIN",
"state": "NC",
"postal_code": "287750099",
"telephone_number": "828-526-9769",
"fax_number": "828-526-8719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "318 LAKESIDE RD",
"city": "SCALY MOUNTAIN",
"state": "NC",
"postal_code": "287750099",
"telephone_number": "828-526-9769",
"fax_number": "828-526-8719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGHT",
"first_name": "CAROLE",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "PND",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "1604",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "297",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "1163W",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CAROLE",
"last_name": "REDMOUNTAIN",
"middle_name": "LIGHT",
"prefix": "MRS.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Scaly Mountain, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.