Provider Demographics
NPI:1023999455
Name:JACKSON-CHAPMAN, HEATHER ALEXIA
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALEXIA
Last Name:JACKSON-CHAPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 W ALEX BELL RD
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-1920
Mailing Address - Country:US
Mailing Address - Phone:937-476-1940
Mailing Address - Fax:937-915-0450
Practice Address - Street 1:3781 W ALEX BELL RD
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1920
Practice Address - Country:US
Practice Address - Phone:937-731-3918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0040246363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health