Provider Demographics
NPI:1629303524
Name:DEMERS, KATHERINE ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANN
Last Name:DEMERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 EASTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2029
Mailing Address - Country:US
Mailing Address - Phone:405-722-4695
Mailing Address - Fax:
Practice Address - Street 1:4205 HWY 66 W
Practice Address - Street 2:HEALTH SERVICES UNIT
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-1000
Practice Address - Country:US
Practice Address - Phone:405-319-7549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant