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STACI R YOUNG MD
NPI 1053406694
Pediatrics in Glen Carbon, IL

Active since October 03, 2006
4804 S STATE ROUTE 159, GLEN CARBON, IL 62034(618) 288-9305(618) 288-9308 Get Directions Write a Review

NPPES record last updated: June 29, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Staci R Young Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACI R YOUNG MD (NPI 1053406694) is an individual pediatrics provider in Glen Carbon, Illinois, licensed in Illinois (036113846) and active in the NPI registry since October 2006.

NPPES Registry Identity

NPI1053406694
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameSTACI R YOUNGCredential: MD
Location Address4804 S STATE ROUTE 159Glen Carbon, IL 62034-1904
Mailing Address4804 S State Route 159Glen Carbon, IL 62034-1904 · (618) 288-9305 · Fax (618) 288-9308
Phone(618) 288-9305
Fax(618) 288-9308
Sole ProprietorYes
Enumeration DateOctober 3, 2006
Last NPPES UpdateJune 29, 2020
NPPES CertifiedJune 29, 2020
✔ NPI 1053406694 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Licenses✔ Licensed in IL · 036113846✔ Licensed in MO · 2005020858
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
4804 S STATE ROUTE 159, Glen Carbon, IL 62034
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Other Names 1

Former Name (1)Staci R Johnson M.d.

Other Identifiers 1

Medicaid06500123IL

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NATIONAL PEDORTHIC SERVICES, INC.
Prosthetic/Orthotic Supplier
4804 S STATE ROUTE 159, SUITE A
GLEN CARBON, IL 62034
Madison County (414) 438-1211
LABORATORYT CORPORATION OF AMERICA
Clinical Medical Laboratory
4804 S STATE ROUTE 159
GLEN CARBON, IL 62034
Madison County (618) 288-7027

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Staci Young's NPI number?

The NPI number for Staci Young is 1053406694. It was assigned to this individual provider in the NPPES registry on October 3, 2006. The provider is also known as Staci R Johnson M.D..

Where is Staci Young located?

Staci Young practices at 4804 S State Route 159, Glen Carbon, IL 62034. The listed phone number is (618) 288-9305.

What is Staci Young's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

When was this NPI record last updated?

The NPPES record for Staci Young was last updated on June 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.