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

Kevin Jackson

Individual provider Registered Nurse · NPI 1306683990

Kevin Jackson is a Certified Registered Nurse Anesthetist (CRNA) in Jackson, Michigan. Qualified in 2025, 1 year ago. Practices with W. A. Foote Memorial Hospital, Inc, a 478-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
1
Licensed in
MI
In the registry since
2024
Specialties on file
2
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Practice location Address checks out

205 N East Ave
Jackson, MI 49201-1753
Phone: (517) 205-4800
Fax: (313) 876-1305
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4001 W McNichols Rd, Detroit, MI 48221-3038 — (313) 993-3373

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 4704357712 (MI)
Registered Nurse Taxonomy 163W00000X · Licence 4704357712 (MI)

Record details

NPI number1306683990
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 10, 2024
Last updated in NPPESSeptember 29, 2025
Certification dateSeptember 29, 2025
Mailing address21527 Bon Heur St, Saint Clair Shores, MI 48081-1937

Medicare enrollment

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

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice W. A. Foote Memorial Hospital, Inc. — 478 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Jackson