KENNETH DEMASTERS
NPI 1073696605
Physician Assistant - Medical in Moore, OK

Active since October 24, 2006
507 NE 12TH ST, MOORE, OK 73160(405) 703-4202 Get Directions Write a Review

NPPES record last updated: May 29, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kenneth Demasters NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH DEMASTERS (NPI 1073696605) is an individual medical provider in Moore, Oklahoma, licensed in Oklahoma (PA1077) and active in the NPI registry since October 2006.

NPPES Registry Identity

NPI1073696605
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameKENNETH DEMASTERS
Location Address507 NE 12TH STMoore, OK 73160-5807
Mailing Address6805 N Woodbrook RdWarr Acres, OK 73132-6413
Sole ProprietorNo
Enumeration DateOctober 24, 2006
Last NPPES UpdateMay 29, 2014
NPI 1073696605 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License Licensed in OK · PA1077
507 NE 12TH ST, Moore, OK 73160

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Family)
507 NE 12TH ST
MOORE, OK 73160
Clinic/Center (Primary Care)
507 NE 12TH ST
MOORE, OK 73160
Podiatrist
507 NE 12TH ST
MOORE, OK 73160
Nurse Practitioner (Family)
507 NE 12TH ST
MOORE, OK 73160
Nurse Practitioner
507 NE 12TH ST
MOORE, OK 73160

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Demasters's NPI number?

The NPI number for Kenneth Demasters is 1073696605. It was assigned to this individual provider in the NPPES registry on October 24, 2006.

Where is Kenneth Demasters located?

Kenneth Demasters practices at 507 NE 12th St, Moore, OK 73160. The listed phone number is (405) 703-4202.

What is Kenneth Demasters's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Kenneth Demasters was last updated on May 29, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.