Healthcare Provider Details

I. General information

NPI: 1720663057
Provider Name (Legal Business Name): CHESTON PAUL ELLIS APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S COUNTRY CLUB RD
EL RENO OK
73036-5427
US

IV. Provider business mailing address

1900 S COUNTRY CLUB RD
EL RENO OK
73036-5427
US

V. Phone/Fax

Practice location:
  • Phone: 405-295-2900
  • Fax:
Mailing address:
  • Phone: 405-350-8100
  • Fax: 405-212-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number201176
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: