Provider Demographics
NPI:1194070458
Name:CHAPPELL, ASHLEY M (ACNS-BC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:M
Last Name:CHAPPELL
Suffix:
Gender:
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1601 BUTTERFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2959
Mailing Address - Country:US
Mailing Address - Phone:815-936-6500
Mailing Address - Fax:815-936-6502
Practice Address - Street 1:1601 BUTTERFIELD TRL
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2959
Practice Address - Country:US
Practice Address - Phone:815-936-6500
Practice Address - Fax:815-936-6502
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009583363LP0808X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209009583OtherIL LICENSE