MEDICARE: KENNETH JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	344600000X	Taxi	008046248	LA

General Provider Information

NPI Number	:	1659743029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH JACKSON

Provider Business Mailing Address
First Line	:	1216 OKLAHOMA ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-3624
Country	:	US
Telephone Number	:	337-419-8236
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 OKLAHOMA ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-3624
Country	:	US
Telephone Number	:	337-419-8236
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MR. KENNETH LEE JACKSON
Credential	:
Telephone Number	:	337-419-8326

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

Similar Medicare Providers

1154058162 — MR. KENNETH LEE JACKSON
Practice Location Address:

1216 OKLAHOMA ST
LAKE CHARLES, LA
70607-3624

Practice Phone: 337-414-0914
Practice Fax:

1326756560 — PIC ME UP MEDICAL TRANSPORTATION SERVICES LLC
Practice Location Address:

1216 OKLAHOMA ST
LAKE CHARLES, LA
70607-3624

Practice Phone: 337-419-8326
Practice Fax:

1376549691 — WHEELCHAIR SPECIALTIES LLC
Practice Location Address:

28480 S LAKE DR
LACOMBE, LA
70445-3624

Practice Phone: 985-218-9699
Practice Fax: 985-218-9699

1265493159 — DR. STEPHEN JOSEPH TERVOLA DDS
Practice Location Address:

3624 E LAKE ST
MINNEAPOLIS, MN
55406-2152

Practice Phone: 612-729-2361
Practice Fax: 612-729-2362

1518976331 — MS. JO LYNN ROHADY MS RN CS
Practice Location Address:

1310 HIGHWAY 96 E
WHITE BEAR LAKE, MN
55110-3624

Practice Phone: 651-426-3071
Practice Fax: 651-426-3095

1629170543 — DENNIS A SMITH M.S.W.
Practice Location Address:

1310 HIGHWAY 96 E , SUITE 202 A
WHITE BEAR LAKE, MN
55110-3624

Practice Phone: 651-587-4531
Practice Fax:

Directions to “KENNETH JACKSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.