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General NPI Number Information
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NPI Number | 1811237001
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Entity Type | Individual
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Provider Name | KENNETH S JACKSON FNP
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Gender | Male
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 123 MAPLE ST
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City | BRUCETON
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State | TN
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Zip | 38317-1819
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Country | US
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Telephone | 731-586-4800
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Fax | 731-352-4459
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Provider Business Mailing Address
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Address Line | 205 HOSPITAL DR SUITE A
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City | MC KENZIE
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State | TN
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Zip | 38201-1649
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Country | US
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Telephone | 731-352-7907
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Fax | 731-352-4459
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 17382
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License Number State | TN
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