Provider Demographics
NPI:1104359728
Name:BERRY, AMANDA N (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:N
Last Name:BERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:B
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 NW 9TH ST
Mailing Address - Street 2:#220
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1070
Mailing Address - Country:US
Mailing Address - Phone:405-272-8498
Mailing Address - Fax:405-272-8425
Practice Address - Street 1:535 NW 9TH ST
Practice Address - Street 2:#220
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1070
Practice Address - Country:US
Practice Address - Phone:405-272-8498
Practice Address - Fax:405-272-8425
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK6418207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program