Individual
OLIVIA ANNE DERRYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11200 N PORTLAND AVE, OKLAHOMA CITY, OK 73120-5045
(405) 496-7348
Mailing address
2501 N BLACKWELDER AVE, OKLAHOMA CITY, OK 73106-1402
(405) 496-7348
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5602
OK
Other
Enumeration date
04/01/2025
Last updated
09/19/2025
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