Provider Demographics
NPI:1841544053
Name:LIGHT, JENNIFER H (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:LIGHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 FORT SANDERS WEST BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3352
Mailing Address - Country:US
Mailing Address - Phone:423-745-5955
Mailing Address - Fax:
Practice Address - Street 1:111 EPPERSON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3478
Practice Address - Country:US
Practice Address - Phone:423-745-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical