MEDICARE: LOVE AND LIGHT FAMILY PRACTICE, PLLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1992638092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE AND LIGHT FAMILY PRACTICE, PLLC

Provider Business Mailing Address
First Line	:	701 GREEN VALLEY RD STE 100
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-7096
Country	:	US
Telephone Number	:	336-609-9105
Fax Number	:	336-313-2526

Provider Business Practice Location Address
First Line	:	5106 BARTHOLOMEWS LN
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-2726
Country	:	US
Telephone Number	:	336-609-9105
Fax Number	:	336-313-2526

Authorized Official
Title or Position	:	OWNER. FOUNDER
Name	:	MS. LE'STARR M ROSE
Credential	:	FNP
Telephone Number	:	248-396-3295

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/09/2026

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