Provider Demographics
NPI:1114055423
Name:CLARK CHAPMAN, JEANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:
Last Name:CLARK CHAPMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 LATHROP ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5943
Mailing Address - Country:US
Mailing Address - Phone:907-456-2825
Mailing Address - Fax:907-451-0742
Practice Address - Street 1:1919 LATHROP ST STE 203
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5943
Practice Address - Country:US
Practice Address - Phone:907-456-2825
Practice Address - Fax:907-451-0742
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK91363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKR14829Medicare UPIN