Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Jackson Rottier

Individual provider Physician Assistant · NPI 1679400279

Jackson Rottier is a Physician Assistant in Edgewood, Kentucky. Practices as a sole proprietor. Licensed in Kentucky.

Licensed in
KY
In the registry since
2026

Practice location Address checks out

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone: (859) 301-9010
Fax: (859) 301-9018
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence TC112 (KY)

Record details

NPI number1679400279
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 6, 2026
Last updated in NPPESOctober 6, 2026
Certification dateMay 6, 2026

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