MEDICARE: HEATHER ALEXIA JACKSON-CHAPMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0040246	OH

General Provider Information

NPI Number	:	1023999455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER ALEXIA JACKSON-CHAPMAN

Provider Business Mailing Address
First Line	:	3781 W ALEX BELL RD
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-1920
Country	:	US
Telephone Number	:	937-476-1940
Fax Number	:	937-915-0450

Provider Business Practice Location Address
First Line	:	3781 W ALEX BELL RD
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-1920
Country	:	US
Telephone Number	:	937-731-3918
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/23/2025

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