Mary Ann Light, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1-052430 Issued in AL

Practice address

796 Ridgeway Ave
Signal Mountain, TN 37377-3067

Phone

(423) 886-3269

NPI assigned

Aug 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

State licenses

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372377600000",
    "number": "1720095086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 772",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028950784",
            "telephone_number": "401-770-5779",
            "fax_number": "401-652-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "796 RIDGEWAY AVE",
            "city": "SIGNAL MOUNTAIN",
            "state": "TN",
            "postal_code": "373773067",
            "telephone_number": "423-886-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2013-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-052430",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "12784",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BOAZ",
            "identifier": "051530068",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891010020",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC FORT PAYNE",
            "identifier": "051530066",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891010030",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chrissy Elaine Knowles, PTA
• Mindy N Lane, LMSW
• Peggy Stottlemyer Larochelle, PT
• Katherine Leister, BCBA
• Dianne Lacey Lewis, M.C.D., CCC-SLP
• Leah Marie Linn, MA
• Sue Wright Martin, PTA
• Joshua Paul Masters
• Elicia Baker Matthews, PT
• Marla Frazier McDaniel, MA, CCC-SLP

• Nurse Practitioner in Signal Mountain, TN
• Providers in Signal Mountain, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.