Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Kenneth Douglas Jackson, MD

Individual provider Family Medicine Physician · NPI 1073510491

Dr. Kenneth Douglas Jackson, MD is an Obstetrics/Gynecology in Kingman, Arizona. Graduated from Baylor College of Medicine in 1974, 52 years ago. Practices with Kingman Healthcare Inc, a 180-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
52
Trained at
Baylor College of Medicine
Licensed in
AZ
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1739 E Beverly Ave Ste 201
Kingman, AZ 86401-3593
Phone: (928) 692-3456
Fax: (928) 692-7071
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 12522 (AZ)

Record details

NPI number1073510491
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 30, 2005
Last updated in NPPESJuly 13, 2026
Mailing address1739 E Beverly Ave, Suite 201, Kingman, AZ 86401-3593

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOBSTETRICS/GYNECOLOGY
Medical schoolBAYLOR COLLEGE OF MEDICINE
Graduated 1974 (52 years in practice)
Group practice Kingman Healthcare Inc — 180 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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