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General NPI Number Information
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NPI Number | 1720653355
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Entity Type | Organization
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Legal Business Name | LYGHT BULB MOMENTS LLC
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 54 HOWE STREET BUILDING A ; PO BOX 105 SUITE 105
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City | RUTLAND
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State | VT
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Zip | 05701-3802
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Country | US
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Telephone | 888-987-3991
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Fax | 888-502-6598
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Provider Business Mailing Address
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Address Line | 12247 BIG CANOE
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City | BIG CANOE
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State | GA
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Zip | 30143-5161
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Country | US
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Telephone | 888-987-3991
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Fax | 888-502-6598
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Authorized Official
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Title or Position | NP
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Name | TINEY RAY
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Credential |
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Telephone | 678-701-4679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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