Provider Demographics
NPI:1720663057
Name:ELLIS, CHESTON PAUL (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CHESTON
Middle Name:PAUL
Last Name:ELLIS
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 WEXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179-1202
Mailing Address - Country:US
Mailing Address - Phone:405-397-0150
Mailing Address - Fax:
Practice Address - Street 1:315 W KANSAS
Practice Address - Street 2:
Practice Address - City:OKARCHE
Practice Address - State:OK
Practice Address - Zip Code:73762-9227
Practice Address - Country:US
Practice Address - Phone:405-263-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201176363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care