Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

KENNETH JAMES JACKSON
NPI 1700790060
Nurse Practitioner - Family in Centerville, OH

Q: What is Kenneth Jackson's NPI number?

The NPI number for Kenneth Jackson is 1700790060. It was assigned to this individual provider in the NPPES registry on October 1, 2026.

Q: What is Kenneth Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kenneth Jackson was last updated on October 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 days 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.

Active since October 01, 2026

7677 YANKEE ST STE 140, CENTERVILLE, OH 45459(937) 293-3486(937) 454-0077 Get Directions Write a Review

NPPES record added: October 1, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About Kenneth James Jackson NPPES

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

KENNETH JAMES JACKSON (NPI 1700790060) is an individual family provider in Centerville, Ohio, licensed in Ohio (APRN.CNP.0043539) and active in the NPI registry since October 2026.

NPPES Registry Identity

NPI1700790060

Entity TypeIndividualMale

Primary Taxonomy363LF0000X

Provider Legal NameKENNETH JAMES JACKSON

Location Address7677 YANKEE ST STE 140Centerville, OH 45459-3475

Mailing Address7677 Yankee St Ste 140Centerville, OH 45459-3475 · (937) 293-3486 · Fax (937) 454-0077

Phone(937) 293-3486

Fax(937) 454-0077

Sole ProprietorNo

Enumeration DateOctober 1, 2026

NPPES CertifiedOctober 1, 2026

✔ NPI 1700790060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in OH · APRN.CNP.0043539

7677 YANKEE ST STE 140, Centerville, OH 45459

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Other Providers at the Same Location NPPES 5

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

BRIAN P SCHWARTZ M.D.

Internal Medicine (Interventional Cardiology)

7677 YANKEE ST STE 140
CENTERVILLE, OH 45459

Montgomery County (937) 454-0012

SHAUNA LOUISE REED PA-C

Physician Assistant (Medical)

7677 YANKEE ST STE 140
CENTERVILLE, OH 45459

Montgomery County (937) 454-9527

ABDUR REHMAN MD

Internal Medicine (Cardiovascular Disease)

7677 YANKEE ST STE 140
CENTERVILLE, OH 45459

Montgomery County (937) 454-9527

CAITLIN CHABUT PA

Physician Assistant

7677 YANKEE ST STE 140
DAYTON, OH 45459

Montgomery County (937) 454-9527

TODD W CHRISTIE PA-C

Physician Assistant

7677 YANKEE ST STE 140
CENTERVILLE, OH 45459

Montgomery County (937) 454-9527

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 Kenneth Jackson's NPI number?

The NPI number for Kenneth Jackson is 1700790060. It was assigned to this individual provider in the NPPES registry on October 1, 2026.

Where is Kenneth Jackson located?

Kenneth Jackson practices at 7677 Yankee St Ste 140, Centerville, OH 45459. The listed phone number is (937) 293-3486.

What is Kenneth Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Kenneth Jackson was last updated on October 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 days 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.