Healthcare Provider Details

I. General information

NPI: 1437063112
Provider Name (Legal Business Name): JAYDEN CHAPMAN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

4102 CEDAR ST APT 8
FORT WAINWRIGHT AK
99703-1359
US

V. Phone/Fax

Practice location:
  • Phone: 801-300-1052
  • Fax:
Mailing address:
  • Phone: 801-300-1052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number25376912
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: