MEDICARE: DR. JEANEEN CHAPPELL M.D.

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	207N00000X	Dermatology Physician	01089686A	IN
2	207N00000X	Dermatology Physician	Q6501	TX

General Provider Information

NPI Number	:	1497915623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANEEN CHAPPELL M.D.

Provider Business Mailing Address
First Line	:	4927 LAKE RIDGE PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4927 LAKE RIDGE PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3087
Country	:	US
Telephone Number	:	817-466-8651
Fax Number	:

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

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	07/06/2023

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