KENNETH JACKSON PA-C
NPI 1033238936
Physician Assistant - Medical in Berkley, MI
Active since March 29, 2007
About Kenneth Jackson Pa-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KENNETH JACKSON PA-C (NPI 1033238936) is an individual medical provider in Berkley, Michigan, licensed in Michigan (5601001747) and active in the NPI registry since March 2007.
NPPES Registry Identity
NPI1033238936
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameKENNETH JACKSONCredential: PA-C
Location Address27901 WOODWARD AVE, SUITE 300Berkley, MI 48072-0919
Mailing Address26901 Beaumont Blvd Ste 3dSouthfield, MI 48033-3849 · Fax (947) 522-0307
Phone(248) 837-2443
Sole ProprietorNo
Enumeration DateMarch 29, 2007
Last NPPES UpdateJanuary 25, 2021
NPPES CertifiedJanuary 25, 2021
✔ NPI 1033238936 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in MI · 5601001747
27901 WOODWARD AVE, Berkley, MI 48072
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Internal Medicine (Cardiovascular Disease)
27901 WOODWARD AVE, SUITE 300
BERKLEY, MI 48072
BERKLEY, MI 48072
Internal Medicine (Cardiovascular Disease)
27901 WOODWARD AVE, SUITE 300
BERKLEY, MI 48072
BERKLEY, MI 48072
Podiatrist
27901 WOODWARD AVE, SUITE 110
BERKLEY, MI 48072
BERKLEY, MI 48072
Internal Medicine (Nephrology)
27901 WOODWARD AVE, SUITE #210
BERKLEY, MI 48072
BERKLEY, MI 48072
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1033238936, enumerated as an "individual" on March 29, 2007.
The provider is located at 27901 WOODWARD AVE SUITE 300 BERKLEY, MI 48072 and the phone number is (248) 837-2443.
Physician Assistant with taxonomy code 363AM0700X and a focus in Medical.
