Individual provider · Type 1 NPI

Keelan Raphael Jackson

Independent Duty Corpsman · Parris Island, SC

NPI number 1790449882 Active

Practice location

670 Boulevard De France
Parris Island, SC 29905

Call (843) 228-4757 Map

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program 390200000XNone listed
Independent Duty Corpsman Primary 1710I1002X1790449882 (SC)

Independent Duty Corpsman: 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 othe…

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About NPI 1790449882

Keelan Raphael Jackson's National Provider Identifier is 1790449882, issued on Oct 26, 2021. The primary taxonomy on file is Independent Duty Corpsman (1710I1002X), and the practice location is in Parris Island, SC. The record was last updated on Aug 4, 2026.