KENNETH JACKSON (PA-C) – Medical Physician Assistant, NPI 1033238936

Medical Physician Assistant

KENNETH JACKSON (PA-C) is a healthcare provider. based in Troy, Michigan. specializing in Medical Physician Assistant. They hold the professional credentials PA-C. They hold a License No. 5601001747 (MI). The NPI Number for KENNETH JACKSON (PA-C) is 1033238936

Main info

Male

45 Years Of Experience

Accepts Medicare Assignment

Name

KENNETH JACKSON (PA-C)

NPI

1033238936

Phone

(248) 585-8233

Address

130 TOWN CENTER DR

Enumeration Date

29 March 2007

Last Update Date

25 January 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2485450070

Graduation Year

1981 (45 years ago)

PAC ID

2668558826

Group Practice PAC ID

9335051093

Professional Enrollment ID

I20080327000729

Contacts

Secure Messaging

kjackson19684@direct.beaumont.edu

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience62

Completeness85

Years active:19State licenses:1Other namesUpdated within 12 months

Provider Addresses for KENNETH JACKSON (PA-C)

130 TOWN CENTER DR
STE 203
TROY, MI 480841744
Phone: (248) 585-8233
Fax: (248) 585-8266
Type: Mailing
26901 BEAUMONT BLVD STE 3D
SOUTHFIELD, MI 480333849
Phone:
Fax: (947) 522-0307
Type: Mailing
27901 WOODWARD AVE
SUITE 300
BERKLEY, MI 480720919
Phone: (248) 837-2443
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48084)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9335051093View full group profile

Name	Specialty	State
DR. MAHER RABAH (DO)	Interventional Cardiology, Cardiovascular Disease (Cardiology)	MI
TAMMIE NALLAMOTHU (CRNA)	-	MI
SUSAN KAY (CRNA)	-	MI
Unknown Individual	-	MI
CHRISTOPHER BOWEN (DO)	O B S T E T R I C S/ G Y N E C O L O G Y	MI
FLORENCE ACOSTA (CRNA)	-	MI
DR. ROBERT STEWART ROBERTSON (MD)	-	MI
CHERYL GIBSON FOUNTAIN (M.D.)	-	MI
JENNIFER HUNG-WEN PENG (M.D.)	O B S T E T R I C S/ G Y N E C O L O G Y	MI
Unknown Individual	-	MI