Keely Jackson, CERTIFIED
Specialist · Macomb, MI
Practice location
21268 Venice DrMacomb, MI 48044-1315
- Phone
- (586) 948-8954
- Fax
- (586) 948-8954
NPI record
- NPI
- 1396044269
- Entity type
- Individual (Type 1)
- Enumeration date
- March 17, 2011
- Last updated
- March 17, 2011
- Sole proprietor
- No
Specialties & taxonomy codes
| Taxonomy | Code | License | State |
|---|---|---|---|
| Specialist Primary | 174400000X |
911223 | CO |
About Keely Jackson
Keely Jackson, CERTIFIED is a healthcare provider registered in the NPI registry with the primary taxonomy Specialist (code 174400000X). The practice location is 21268 Venice Dr, Macomb, MI 48044-1315. The NPI number 1396044269 was assigned on March 17, 2011 and the record was last updated on March 17, 2011.
Keely Jackson lists a license in the registry: #911223 (CO) for Specialist. License numbers are self-reported to NPPES; verify them with the state licensing board.
Frequently asked questions
What is the NPI number of Keely Jackson, CERTIFIED?
The NPI number is 1396044269.
What is the phone number of Keely Jackson?
The phone number listed for the practice location is (586) 948-8954.
Where is Keely Jackson located?
21268 Venice Dr, Macomb, MI 48044-1315.
What is the taxonomy code for Keely Jackson?
The primary taxonomy code is 174400000X – Specialist.
Is this information correct?
All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.
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