Healthcare Provider Details

I. General information

NPI: 1922764604
Provider Name (Legal Business Name): 20LIGHTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 W MARKHAM ST STE 234
LITTLE ROCK AR
72205-2128
US

IV. Provider business mailing address

1903 S GREELEY HWY # 324
CHEYENNE WY
82007-3447
US

V. Phone/Fax

Practice location:
  • Phone: 307-287-1555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA BARNES
Title or Position: CEO
Credential: PHD
Phone: 307-287-1555