Individual
DR. KENNETH WADE JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 SKYLAND INN DR FL 2, ARDEN, NC 28704-7714
(828) 654-5005
(828) 654-3257
Mailing address
PO BOX 1869, FLETCHER, NC 28732-1869
(828) 687-5698
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
9801313
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11453742
CAQH
NC
01
—
136RM
BLUE CROSS
NC
01
—
2169383
UNITED HEALTHCARE
NC
05
—
89136RM
—
NC
Enumeration date
05/16/2006
Last updated
03/04/2021
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