MEDICARE: MRS. CHIQUITA LIGHTNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	011293737	SC

General Provider Information

NPI Number	:	1699563429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHIQUITA LIGHTNER

Provider Business Mailing Address
First Line	:	677 LYNVILLE LN
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-9052
Country	:	US
Telephone Number	:	803-517-5565
Fax Number	:

Provider Business Practice Location Address
First Line	:	677 LYNVILLE LN
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-9052
Country	:	US
Telephone Number	:	803-517-5565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/30/2025

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