Provider Demographics
NPI:1922709575
Name:LIGHTBOURNE, KARA JANELLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:JANELLE
Last Name:LIGHTBOURNE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 E WOODFIELD RD STE 402
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4958
Mailing Address - Country:US
Mailing Address - Phone:253-346-0133
Mailing Address - Fax:
Practice Address - Street 1:1699 E WOODFIELD RD STE 402
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4958
Practice Address - Country:US
Practice Address - Phone:253-346-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026160363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily