KENNETH JACKSON (NPI# 1033238936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033238936 |
| Entity Type | Individual |
| Full Name | KENNETH JACKSON |
| Credential | PA-C |
| Practice Address |
27901 Woodward Ave Suite 300 Berkley MI 48072-0919 |
| Mailing Address |
130 Town Center Dr Ste 203 Troy MI 48084-1744 |
| Practice Telephone | 2488372443 |
| Mailing Telephone | 2485858233 |
| Mailing Fax Number | 2485858266 |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2016-06-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601001747 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174083810 | Kenneth Jason Jackson | Student in an Organized Health Care Education/Training Program | 320 23rd St S Apt 1418, Arlington, VA 22202-3773 | 2019-03-20 |
| 1639469026 | Kenneth T Jackson | Counselor | 25506 Virginia Dr, Warren, MI 48091-6002 | 2011-04-19 |
| 1396968863 | Kenneth J Jackson | Dentist | 809 Redskin Trail, Wapakoneta, OH 45895 | 2007-04-11 |
| 1972510352 | Kenneth Wayne Jackson | Nurse Practitioner | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2006-08-01 |
| 1487606943 | Kenneth Wade Jackson Jr. | Obstetrics & Gynecology | 22 Manningfield Dr, Fletcher, NC 28732-9457 | 2006-05-16 |
| 1275514994 | Kenneth Conrad Jackson II | Pharmacist | 546 Chipeta Way, Suite 220, Salt Lake City, UT 84108-1236 | 2005-11-09 |
| 1407409063 | Kenneth Jackson | Technician | 1005 Terminal Way Ste 125, Reno, NV 89502-2198 | 2019-07-22 |
| 1457857690 | Kenneth D Jackson | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-05 |
| 1528573714 | Kenneth Jackson | Case Manager/Care Coordinator | 1501 Madison Rd, Walnut Hills, OH 45206-1706 | 2017-12-10 |
| 1003328550 | Kenneth Lee Jackson Jr. | Counselor | 1430 S High St Fl 4, Columbus, OH 43207-1045 | 2017-10-24 |
| Street Address |
27901 WOODWARD AVE SUITE 300 |
| City | BERKLEY |
| State | MI |
| Zip Code | 48072-0919 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225015191 | Jeffrey C Kalt | Ophthalmology | 27901 Woodward Ave, Ste 200, Berkley, MI 48072 | 2005-12-30 |
| 1508239104 | Abdulgadir Adam Md Pllc | Internal Medicine | 27901 Woodward Ave, Suite 220, Berkley, MI 48072-0919 | 2015-11-04 |
| 1316319262 | Sanjay Dogra Md Pllc | Internal Medicine | 27901 Woodward Ave, Suite 220, Berkley, MI 48072-0919 | 2015-10-30 |
| 1689075020 | Chanta L. Stanley | Registered Nurse | 27901 Woodward Ave, 300, Berkley, MI 48072-0919 | 2014-09-04 |
| 1093083743 | Lauren Elissa Taboh | Registered Nurse | 27901 Woodward Ave, Suite 220, Berkley, MI 48072-0919 | 2011-12-08 |
| 1487936456 | Tanya S Postwaite | Physician Assistant | 27901 Woodward Ave, Suite 300, Berkley, MI 48072-0919 | 2011-09-15 |
| 1457539116 | Barak Tanzman | Surgery | 27901 Woodward Ave, Suite 100, Berkley, MI 48072-0919 | 2008-02-05 |
| 1790981413 | Chau Plastic Surgery PC | Plastic Surgery | 27901 Woodward Ave, Suite 100, Berkley, MI 48072-0919 | 2007-06-21 |
| 1982818738 | David M Nori | Internal Medicine | 27901 Woodward Ave, Suite 300, Berkley, MI 48072-0919 | 2007-05-10 |
| 1184837890 | Dr Richard L Grant P L C | Podiatrist | 27901 Woodward Ave, Suite 110, Berkley, MI 48072-0919 | 2007-05-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336759539 | Embodied Wellness, Pllc | Counselor | 1354 Harvard Rd, Berkley, MI 48072 | 2020-08-03 |
| 1790202224 | Medcrafters Rx Pharmacy LLC | Pharmacy | 3348 W 12 Mile Rd, Berkley, MI 48072 | 2017-08-25 |
| 1144684861 | Marilyn Ann Hawkins | Registered Nurse | 2766 West 11 Mile Rd., Beckley, MI 48072 | 2016-04-08 |
| 1134547862 | Rimma Polevoy | Internal Medicine | 1949 12 Mile Rd Ste 100, Berkley, MI 48072 | 2014-03-31 |
| 1245676212 | Chelsea Peraino Smoots | Social Worker | 892 11 Mile Rd, Berkley, MI 48072 | 2013-05-17 |
| 1770730483 | Bryce Paul Roekle | Counselor | 1799 Phillips Avenue, Berkley, MI 48072 | 2008-08-25 |
| 1003003617 | Oakland Family Services | Community/Behavioral Health | 2351 West 12 Mile Road, Berkley, MI 48072 | 2007-09-27 |
| 1063605012 | Care Plus Home Health Services, Inc | Home Health | 28139 Woodward Ave, Berkley, MI 48072 | 2007-08-23 |
| 1346370020 | David Jason Carpenter | Social Worker | 2345 West 12 Mile Road, Berkley, MI 48072 | 2007-03-06 |
| 1871674192 | Robert Igwe | Internal Medicine | 1949 West Twelve Mile Rd, Ste 200, Berkley, MI 48072 | 2006-10-17 |
| Find all providers in zip 48072 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831756717 | Colin J Colter | Physician Assistant | 1964 W 11 Mile Rd Ste 1, Berkley, MI 48072-3046 | 2019-05-25 |
| 1588101091 | Mark Rosen | Physician Assistant | 1964 W 11 Mile Rd, Berkley, MI 48072-3046 | 2017-01-22 |
| 1487936456 | Tanya S Postwaite | Physician Assistant | 27901 Woodward Ave, Suite 300, Berkley, MI 48072-0919 | 2011-09-15 |
| 1831490622 | Zhengbo Duanmu | Physician Assistant | 2905 W 12 Mile Rd, Berkley, MI 48072-1413 | 2010-11-09 |
| 1235366014 | Caleb Anthony Youngblood | Physician Assistant | 1964 W 11 Mile Rd, Berkley, MI 48072-3046 | 2009-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616687 | Alexandria Jaclyn Miller | Physician Assistant | 4700 Chipman Dr, Waterford, MI 48327-3413 | 2020-10-15 |
| 1639777287 | Piotr Z Purzycki | Physician Assistant | 41400 Dequindre Rd Ste 101, Sterling Heights, MI 48314-3751 | 2020-10-15 |
| 1013524859 | Amber Marie Lee | Physician Assistant | 2265 South Lindenroad, Suite A, Flint, MI 48532 | 2020-09-25 |
| 1326656844 | Dominic Farrell | Physician Assistant | 224 Portchester Rd, Holland, MI 49424-2628 | 2020-07-21 |
| 1982212072 | Alexandria Bower-nelson | Physician Assistant | 1302 Porter Drive, Charlotte, MI 48813 | 2020-07-15 |
| 1013535343 | Maria Pavia | Physician Assistant | 41302 Scarborough Ln, Novi, MI 48375-2893 | 2020-07-13 |
| 1073130241 | Kelly F Esper | Physician Assistant | 9043 Glenwood Ln, Northville, MI 48168-9129 | 2020-07-02 |
| 1811513971 | Tasha Baker | Physician Assistant | 5444 E Whitefeather Rd, Pinconning, MI 48650-8407 | 2020-06-24 |
| 1437770054 | Sterling Ryan Maxfield | Physician Assistant | 6187 Oak Grove Rd, Howell, MI 48855-8247 | 2020-05-05 |
| 1760018808 | Rachel Renee Mackmin | Physician Assistant | 41498 Mary Kay Dr, Clinton Township, MI 48038-1989 | 2020-03-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.