KENNETH JACKSON PA-C NPI 1033238936

NPI Information

  • NPI: 1033238936
  • Provider Name: KENNETH JACKSON, PA-C
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • Address: 27901 WOODWARD AVE
    SUITE 300
    BERKLEY, MI
    ZIP 48072
  • Phone: (248) 837-2443

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NPI Details

Kenneth Jackson, PA-C is a medical physician assistant in Berkley, MI. Kenneth Jackson, PA-C NPI is 1033238936. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

27901 WOODWARD AVE
SUITE 300
BERKLEY, MI
ZIP 48072-919
Phone: (248) 837-2443

The enumeration date for this NPI number is 3/29/2007 and was last updated on 1/25/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedical5601001747MICHIGANYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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