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

Keelan Raphael Jackson

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1790449882

Keelan Raphael Jackson is a Student in an Organized Health Care Education/Training Program in Parris Island, South Carolina. Licensed in South Carolina. Registered with an NPI since 2021.

Licensed in
SC
In the registry since
2021
Specialties on file
2

Practice location Address checks out

670 Boulevard De France
Parris Island, SC 29905
Phone: (843) 228-4757
Show map & directions

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

Specialties & licences

Independent Duty Corpsman (primary) Taxonomy 1710I1002X · Licence 1790449882 (SC)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1790449882
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedOctober 26, 2021
Last updated in NPPESAugust 4, 2026
Certification dateAugust 4, 2026

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