Provider Demographics
NPI:1720653355
Name:LYGHT BULB MOMENTS LLC
Entity type:Organization
Organization Name:LYGHT BULB MOMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:TINEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-701-4679
Mailing Address - Street 1:12247 BIG CANOE
Mailing Address - Street 2:
Mailing Address - City:BIG CANOE
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5161
Mailing Address - Country:US
Mailing Address - Phone:888-987-3991
Mailing Address - Fax:888-502-6598
Practice Address - Street 1:54 HOWE STREET
Practice Address - Street 2:BUILDING A ; PO BOX 105 SUITE 105
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3802
Practice Address - Country:US
Practice Address - Phone:888-987-3991
Practice Address - Fax:888-502-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty