Healthcare Provider Details

I. General information

NPI: 1639066582
Provider Name (Legal Business Name): CYNDI ANN LIGHTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 NICHOLAS ST
RUPERT WV
25984-7703
US

IV. Provider business mailing address

PO BOX 560 321 NICHOLAS ST.
RUPERT WV
25984-0560
US

V. Phone/Fax

Practice location:
  • Phone: 304-661-1669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number3747P1801X
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: