Basic Information
| Provider Information | |||||||||
| NPI: | 1275279879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAPMAN | ||||||||
| FirstName: | RAEGAN | ||||||||
| MiddleName: | JAYE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 W LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | LINDSBORG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674562328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852433371 | ||||||||
| FaxNumber: | 7852274130 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 W LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | LINDSBORG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674562328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852273308 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2022 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 30004856720001 | 05 | KS | MEDICAID |