Provider Demographics
NPI:1427828664
Name:LIGHTFOOT, MYAA (PHARMD, BCPP)
Entity type:Individual
Prefix:
First Name:MYAA
Middle Name:
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-2936
Mailing Address - Country:US
Mailing Address - Phone:859-489-2507
Mailing Address - Fax:
Practice Address - Street 1:327 CALDWELL DR STE 500
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3410
Practice Address - Country:US
Practice Address - Phone:615-239-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN402441835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric