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

Kenneth William Jackson, PA

Individual provider Physician Assistant · NPI 1194587824

Kenneth William Jackson, PA is a Physician Assistant in Idaho Falls, Idaho. Qualified in 2024, 2 years ago. Practices with Baptist Health Medical Group Inc, a 2,445-clinician group and accepts Medicare assignment. Licensed in Idaho and Kentucky.

Years since qualifying
2
Licensed in
ID, KY
In the registry since
2024
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3200 Channing Way Ste A206
Idaho Falls, ID 83404-7586
Phone: (208) 529-2230
Fax: (208) 561-8061
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7871497 (ID)
Physician Assistant Taxonomy 363A00000X · Licence TC075 (KY)

Record details

NPI number1194587824
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJanuary 29, 2024
Last updated in NPPESJune 9, 2026
Certification dateJune 9, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Baptist Health Medical Group Inc — 2445 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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