Individual
MR. CHESTER ALAN HENDERSHOT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHA,MHS, PA-C
Contact information
Practice address
709 N CZECH HALL RD, YUKON, OK 73099-7897
(405) 949-8600
Mailing address
3108 NW 184TH ST, EDMOND, OK 73012-9650
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2821
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1149304
NCCPA
—
01
—
PA2821
OKLAHOMA STATE MEDICAL BOARD OF LICENSURE AND SUPERVISION
OK
Enumeration date
12/14/2017
Last updated
06/09/2023
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