Provider Demographics
NPI:1215974811
Name:CHAPMAN, JENNIFER HUGHES (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HUGHES
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 HICKORY TREE ROAD
Mailing Address - Street 2:WFUHS
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9243
Mailing Address - Country:US
Mailing Address - Phone:336-764-3304
Mailing Address - Fax:336-764-1018
Practice Address - Street 1:799 HICKORY TREE RD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-9139
Practice Address - Country:US
Practice Address - Phone:336-764-3304
Practice Address - Fax:336-764-1018
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000440363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC3803A569Medicare PIN
NCQ70752Medicare UPIN