Kenneth Demasters

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA1077 Issued in OK

Practice address

507 NE 12TH St
Moore, OK 73160-5807

Phone

(405) 703-4202

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401321600000",
    "number": "1073696605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 N WOODBROOK RD",
            "city": "WARR ACRES",
            "state": "OK",
            "postal_code": "731326413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 NE 12TH ST",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731605807",
            "telephone_number": "405-703-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMASTERS",
        "first_name": "KENNETH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2014-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "PA1077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Indigo Drew Vincent Deberry, MD
• Khrisda Paige Decker
• Edward Carl Deemer, DC
• Allison Clanton Deimund, M.A., CCC-SLP
• Vanessa Renee Delgadillo
• Deni Foughty PH.D PLLC (Scissortail Therapies)
• Dental Depot of Moore, PLLC
• Dental Depot Orthodontics Moore, PLLC
• Dental Professionals of Oklahoma, PC (Little River Dental Care)
• Dentists of Moore and Orthodontics

• Medical Physician Assistant in Moore, OK
• Providers in Moore, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.