Olivia Anne Derryberry, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5602 Issued in OK

Practice address

11101 Hefner Pointe Dr
Oklahoma City, OK 73120-0600

Phone

(580) 223-0447

NPI assigned

Apr 1, 2025

Sex

Female

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

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oklahoma City Gynecology and Obstetrics, LLCGroup PAC ID 4284684606, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: olivia.derryberry.1@3062.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oklahoma City Gynecology and Obstetrics, LLC

  • Obstetrics & Gynecology Physician
  • Oklahoma City, OK
  • NPI 1114987633
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1743465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785715200000",
    "number": "1154124261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1716 NW 19TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731063802",
            "telephone_number": "405-496-7348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11101 HEFNER POINTE DR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731200600",
            "telephone_number": "580-223-0447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRYBERRY",
        "first_name": "OLIVIA",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-01",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "5602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Derouen
• Felix J Derousselle
• Elizabeth Derr, LPC
• Brett Derrevere, MD
• Broc S Derryberry, DC
• Madeline Derting
• Aditya Desai, MD
• Karishma Desai, MD
• Nidhi Bimal Desai, MD
• Leon Renault Desecottier

• Physician Assistant in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.