| Doctor Name: | HASKELL RAY DERRYBERRY |
| NPI Number: | 1093755704 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 582138 |
| Business Practice Address: | 1322 Paluxy Rd Suite #2 Granbury, TX - 760485603 |
| Business Phone Number: | 8175791642 |
| Business Fax Number: | 8175799926 |
| Mailing Address: | 1322 Paluxy Rd, Suite 2 GRANBURY |
| State: | TX |
| Postal Code: | 760485603 |
| Phone Number: | 8175791642 |
| Fax Number: | |
| NPI Enumeration Date: | 06/08/2006 |
| NPI Last Update Date: | 06/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 582138 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |