Kevin Jackson

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704357712 Issued in MI

Practice address

205 N East Ave
Jackson, MI 49201-1753

Phone

(517) 205-4800

Fax

(313) 876-1305

NPI assigned

Jul 10, 2024

Last updated

Sep 29, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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 MI

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

W. a. Foote Memorial Hospital, Inc.Group PAC ID 0244136067, 476 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092

Medicare enrollment (NPD)

Enrolled

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.

• W.a. Foote Memorial Hospital

  dba Allegiance Health

  • Certified Registered Nurse Anesthetist
  • Jackson, MI
  • NPI 1598776718

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• W.a. Foote Memorial Hospital, Inc

  dba Henry Ford Allegiance Health

  • Physician Assistant
  • Jackson, MI
  • NPI 1538606348
  NPD

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

• W.a. Foote Memorial Hospital

  dba Henry Ford Allegiance Health

  • General Acute Care Hospital
  • Jackson, MI
  • NPI 1053403402
  Care Compare affiliation

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

{
    "created_epoch": "1720569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1306683990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21527 BON HEUR ST",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811937",
            "telephone_number": "248-760-3640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-205-4800",
            "fax_number": "313-876-1305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4001 W McNichols Rd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482213038",
            "country_code": "US",
            "telephone_number": "313-993-3373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-10",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704357712",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704357712",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson-Hillsdale Community Mental Health Board (Lifeways)
• Jackson-Hillsdale Community Mental Health Board (LifeWays)
• Jackson-Hillsdale Community Mental Health Board (Lifeways)
• Jackson-Hillsdale Community Mental Health Board (LifeWays)
• Jackson-Hillsdale Community Mental Health Board (Lifeways)
• Laquita Jackson, LLBSW
• Lesley Tyesha Jackson, FNP
• Michael Timothy Jackson Sr., BSW
• Miles Jackson, MD
• Ronald Duane Jackson, MALLPC

• Certified Registered Nurse Anesthetist in Jackson, MI
• Providers in Jackson, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.