Provider Demographics
NPI:1972608529
Name:YOUNG-LIGHTBODY, KARON (MD)
Entity type:Individual
Prefix:DR
First Name:KARON
Middle Name:
Last Name:YOUNG-LIGHTBODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S. WILLIAM BARNETT AVE.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327
Mailing Address - Country:US
Mailing Address - Phone:281-592-9775
Mailing Address - Fax:281-592-1570
Practice Address - Street 1:309 HWY 59 SOUTH LOOP
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:936-327-1055
Practice Address - Fax:281-592-1570
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101235134208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA302301OtherSOUTHERN HEALTH
VA010085497Medicaid
NCD5144OtherMEDCOST NC
VA144244OtherANTHEM
VA010085497Medicaid