Individual
KENNETH WILLIAM JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3200 CHANNING WAY STE A206, IDAHO FALLS, ID 83404-7586
(208) 529-2230
(208) 561-8061
Mailing address
3200 CHANNING WAY STE A206, IDAHO FALLS, ID 83404-7586
(208) 529-2230
(208) 561-8061
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7871497
ID
363A00000X
Physician Assistant
TC075
KY
Other
Enumeration date
01/29/2024
Last updated
06/09/2026
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