Provider Demographics
NPI:1700776408
Name:CHAPMAN, JESSICA RAYLENE (CDCA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAYLENE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:LILLIANA
Other - Middle Name:RAYLENE
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:835 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-4406
Mailing Address - Country:US
Mailing Address - Phone:937-206-2647
Mailing Address - Fax:
Practice Address - Street 1:2317 E HOME RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2520
Practice Address - Country:US
Practice Address - Phone:937-817-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty