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NPI Code Detail

MEDICARE: KELLY MARIE LIGHTLE

MEDICARE: KELLY MARIE LIGHTLE
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1083556567
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MARIE LIGHTLE
Provider Business Mailing Address
First Line : 109 CHESTNUT ST
Second Line :
City : LEXINGTON
State : NC
Zip : 27292-2313
Country : US
Telephone Number : 336-493-6600
Fax Number :
Provider Business Practice Location Address
First Line : 109 CHESTNUT ST
Second Line :
City : LEXINGTON
State : NC
Zip : 27292-2313
Country : US
Telephone Number : 336-493-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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