Individual provider · Type 1 NPI

Kenneth Jackson, PA-C

Medical Physician Assistant · Berkley, MI

NPI number 1033238936 Active

Practice location

27901 Woodward Ave, Suite 300
Berkley, MI 48072-0919

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X5601001747 (MI)

Medical Physician Assistant: Definition to come...

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About NPI 1033238936

Kenneth Jackson, PA-C's National Provider Identifier is 1033238936, issued on Mar 29, 2007. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Berkley, MI. The record was last updated on Jan 25, 2021.