Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KEVIN ANTHONY JACKSON
Active Sole ProprietorKEVIN ANTHONY JACKSON is a Driver healthcare provider located in LAKE HAVASU CITY, Arizona. NPI 1427829548 is currently active in the NPPES registry. Verify at CMS.
Driver · LAKE HAVASU CITY, AZ
Registration Details
- NPI Number
- 1427829548
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jan 9, 2024 (2.5680808342021 yrs)
- Last Updated
- Jan 9, 2024
- License
-
D08566611 (AZ)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2470 CONSTELLATION DR UNIT 103LAKE HAVASU CITY, AZ, 864034944Browse AZ providers · Browse ZIP 86403
- Phone
- 3104848432
- Primary Specialty
-
Driver
172A00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.