Kenneth Karl Jackson, RRT

Primary specialty

Registered Respiratory TherapistTaxonomy code 227900000X

License

CRT200406 Issued in LA

Practice address

2495 Shreveport Hwy # 71
Pineville, LA 71360-4044

Phone

(318) 466-2396

NPI assigned

Dec 30, 2024

Last updated

Dec 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1735516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1164230694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5503 HALL ST",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713033918",
            "telephone_number": "337-780-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2495 SHREVEPORT HWY # 71",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713604044",
            "telephone_number": "318-466-2396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KENNETH",
        "middle_name": "KARL",
        "name_prefix": "Mr.",
        "credential": "RRT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-12-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "227900000X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered",
            "state": "LA",
            "license": "CRT200406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohamed Issa
• Ziad Issa
• Belvia Ann Jackson-Smith, LCSW
• Danny J. Jackson Sr., P.D.
• Keatrina Marie Jackson, RPH
• Robin Caprice Jackson
• Samia Jada
• James E. Wallace, Jr, M.D., LLC
• Amber M James, FNP-C
• Amy Jameson, O.T.

• Registered Respiratory Therapist in Pineville, LA
• Providers in Pineville, LA by specialty
• Registered Respiratory Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.