NPI 1790449882

Keelan Raphael Jackson

Practitioner Independent Duty Corpsman Parris Island, SC

Practice location

Address: 670 Boulevard de France, Parris Island, SC 29905
Phone: (843) 228-4757

Registered specialties (2)

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X Licence 1790449882 (SC)

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Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X

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Registry record

NPI: 1790449882
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Oct 2021
Record last updated: 4 Aug 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.