KEELAN RAPHAEL JACKSON
NPI 1790449882
Military Health Care Provider - Independent Duty Corpsman in San Diego, CA

Q: What is Keelan Jackson's NPI number?

The NPI number for Keelan Jackson is 1790449882. It was assigned to this individual provider in the NPPES registry on October 26, 2021.

Q: What is Keelan Jackson's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

Q: When was this NPI record last updated?

The NPPES record for Keelan Jackson was last updated on June 15, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since October 26, 2021

34899 BOB WILSON DR, SAN DIEGO, CA 92134(619) 532-6400 Get Directions Write a Review

NPPES record last updated: June 15, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Keelan Raphael Jackson NPPES

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

KEELAN RAPHAEL JACKSON (NPI 1790449882) is an individual independent duty corpsman provider in San Diego, California and active in the NPI registry since October 2021.

NPPES Registry Identity

NPI1790449882

Entity TypeIndividualMale

Primary Taxonomy1710I1002X

Provider Legal NameKEELAN RAPHAEL JACKSON

Location Address34899 BOB WILSON DRSan Diego, CA 92134-0001

Mailing Address34101 Farenholt Ave Bldg 14San Diego, CA 92134-7000 · (619) 532-6559

Phone(619) 532-6400

Sole ProprietorNo

Enumeration DateOctober 26, 2021

Last NPPES UpdateJune 15, 2022

NPPES CertifiedJune 15, 2022

✔ NPI 1790449882 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers

Taxonomy Code1710I1002X

Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

34899 BOB WILSON DR, San Diego, CA 92134

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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 Keelan Jackson's NPI number?

The NPI number for Keelan Jackson is 1790449882. It was assigned to this individual provider in the NPPES registry on October 26, 2021.

Where is Keelan Jackson located?

Keelan Jackson practices at 34899 Bob Wilson Dr, San Diego, CA 92134. The listed phone number is (619) 532-6400.

What is Keelan Jackson's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

When was this NPI record last updated?

The NPPES record for Keelan Jackson was last updated on June 15, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.