MEDICARE: DR. KENDRA KARENE JACKSON MD

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	208000000X	Pediatrics Physician	MDRE.ML.70114303	WA

General Provider Information

NPI Number	:	1790624666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENDRA KARENE JACKSON MD

Provider Business Mailing Address
First Line	:	4800 SAND POINT WAY NE
Second Line	:	OC.7.830
City	:	SEATTLE
State	:	WA
Zip	:	98105
Country	:	US
Telephone Number	:	206-987-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 SAND POINT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-3901
Country	:	US
Telephone Number	:	206-987-2525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	06/03/2026

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