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Keelan Raphael Jackson
Independent Duty Corpsman in San Diego, California
NPI 1790449882

Keelan Raphael Jackson is a Independent Duty Corpsman based in San Diego, CA and is specialized in Independent Duty Corpsman. Keelan Raphael Jackson practices in San Diego, CA. The NPI Number for Keelan Raphael Jackson is 1790449882 and holds a License No. (California).

The current practice location address for Keelan Raphael Jackson is 34899 Bob Wilson Dr, San Diego, CA and can be reached out via phone at 619-532-6400.

Location: 34899 Bob Wilson Dr, San Diego, CA, 92134-7000
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1790449882
Provider Name
Keelan Raphael Jackson
Credential
Provider Entity Type
Individual
Gender
Male
Address
34899 Bob Wilson Dr, San Diego, CA, 92134-7000
Phone Number
619-532-6400
Fax Number
Provider Enumeration Date
10/26/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
34899 Bob Wilson Dr
City
San Diego
State
California
Zip
92134-0001
Phone Number
619-532-6400
Fax Number
person
Provider Business Mailing Address Details
Address
34899 Bob Wilson Dr
City
San Diego
State
California
Zip
92134-0001
Phone Number
619-532-6400
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
Independent Duty Corpsman
Taxonomy
1710I1002X
License No.
(California)
Definition
A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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