Provider Demographics
NPI:1063468650
Name:ARCHER-WEBB, DEVORAH (PA)
Entity type:Individual
Prefix:
First Name:DEVORAH
Middle Name:
Last Name:ARCHER-WEBB
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 1:8106 N MAY AVE STE J
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4524
Mailing Address - Country:US
Mailing Address - Phone:405-632-4616
Mailing Address - Fax:
Practice Address - Street 1:8106 N MAY AVE STE J
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4524
Practice Address - Country:US
Practice Address - Phone:405-632-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1107363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00297647Medicare PIN
OKQ04992Medicare UPIN