Healthcare Provider Details

I. General information

NPI: 1700776408
Provider Name (Legal Business Name): JESSICA RAYLENE CHAPMAN CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LILLIANA RAYLENE STEVENS

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 E HOME RD
SPRINGFIELD OH
45503-2520
US

IV. Provider business mailing address

835 E COLUMBIA ST
SPRINGFIELD OH
45503-4406
US

V. Phone/Fax

Practice location:
  • Phone: 937-817-4095
  • Fax:
Mailing address:
  • Phone: 937-206-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: