Provider Demographics
NPI:1730905498
Name:HERRON, CHESTER L
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:L
Last Name:HERRON
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16603 US HIGHWAY 271
Mailing Address - Street 2:
Mailing Address - City:SPIRO
Mailing Address - State:OK
Mailing Address - Zip Code:74959-5284
Mailing Address - Country:US
Mailing Address - Phone:602-686-3662
Mailing Address - Fax:
Practice Address - Street 1:15949 US HIGHWAY 271
Practice Address - Street 2:
Practice Address - City:SPIRO
Practice Address - State:OK
Practice Address - Zip Code:74959-5276
Practice Address - Country:US
Practice Address - Phone:918-839-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty