Kenneth William Jackson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7871497 Issued in ID

Practice address

3200 Channing Way Ste A206
Idaho Falls, ID 83404-7586

Phone

(208) 529-2230

Fax

(208) 561-8061

NPI assigned

Jan 29, 2024

Last updated

Jun 9, 2026By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Steele Lake Specialty PLLCGroup PAC ID 1153774567, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Corbin Hospital, Corbin, KY, CCN 180080

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Steele Lake Specialty PLLC

  • Surgery Physician
  • Idaho Falls, ID
  • NPI 1215716998
  Medicare reassignment Care Compare group NPD
• Baptist Health Medical Group Inc

  • Nurse Practitioner
  • Lexington, KY
  • NPI 1518360296
  Medicare reassignment Care Compare group
• Baptist Health Medical Group Inc

  • Nurse Practitioner
  • Nicholasville, KY
  • NPI 1255805586

  Family Medicine

  NPD
• Baptist Health Medical Group Inc

  dba Dawson Springs Rural Health Clinic

  • Rural Health Clinic/Center
  • Dawson Springs, KY
  • NPI 1982178216
  NPD
• Idaho Physician Services Inc.

  dba East Falls Orthopedics

  • Orthopaedic Surgery Physician
  • Idaho Falls, ID
  • NPI 1902841893
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Healthcare System, Inc

  dba Baptist Health Corbin

  • General Acute Care Hospital
  • Corbin, KY
  • NPI 1902865389
  Care Compare affiliation

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

{
    "created_epoch": "1706486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1194587824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE A206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047586",
            "telephone_number": "208-529-2230",
            "fax_number": "208-561-8061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE A206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047586",
            "telephone_number": "208-529-2230",
            "fax_number": "208-561-8061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KENNETH",
        "middle_name": "WILLIAM",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-29",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "7871497",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC075",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leili Izadi
• J&V Services, Inc. (Thrive Integrative Counseling)
• Alyssa May Jack, PA-C
• Dallin Jackman
• Beverly Joanne Jackson
• Lyle Jeremy Jackson, CRNA
• Brandon Thomas Jacobson, DMD
• Brett Dean Jacobson, DDS
• Lance Glen Jacobson, MD
• Jennifer Jahn

• Physician Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.