Provider Demographics
NPI:1568741858
Name:CHAPMAN, ALANNA R (PA-C)
Entity Type:Individual
Prefix:
First Name:ALANNA
Middle Name:R
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALANNA
Other - Middle Name:
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:FAITH
Mailing Address - State:SD
Mailing Address - Zip Code:57626-0305
Mailing Address - Country:US
Mailing Address - Phone:605-645-8731
Mailing Address - Fax:
Practice Address - Street 1:112 N 2ND AVE W
Practice Address - Street 2:
Practice Address - City:FAITH
Practice Address - State:SD
Practice Address - Zip Code:57626-0577
Practice Address - Country:US
Practice Address - Phone:605-645-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3318363A00000X
SD0989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO023666OtherKAISER COMMERCIAL NUMBER
CO68489323Medicaid
CO023666OtherKAISER COMMERCIAL NUMBER