Provider Demographics
NPI:1285421255
Name:CHANDLER, JESSICA DELORIS (PA PROGRAM MANGER)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DELORIS
Last Name:CHANDLER
Suffix:
Gender:
Credentials:PA PROGRAM MANGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 S EDWIN C MOSES BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-4036
Mailing Address - Country:US
Mailing Address - Phone:937-396-1052
Mailing Address - Fax:
Practice Address - Street 1:1313 S EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-4036
Practice Address - Country:US
Practice Address - Phone:937-396-1052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide