Jackson, Kenneth Douglas

Jackson, Kenneth Douglas is an individual health care provider with primary practice located at 1739 E Beverly Ave Suite 201, Kingman AZ 86401-3593. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jackson, Kenneth Douglas can be contacted via phone (928) 692-3456.

Contact Information

Primary practice address
1739 E Beverly Ave Suite 201 Kingman AZ 86401-3593
Phone: (928) 692-3456
Fax: (928) 692-7071
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 12522 Arizona

Profile Details

NPI number 1073510491
LBN Legal business name Jackson, Kenneth Douglas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2005
Last updated Mar 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073510491 NPPES
Arizona MEDICAID 209991
Arizona Other 12522

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