Healthcare Provider Details

I. General information

NPI: 1194680819
Provider Name (Legal Business Name): JESSICA G COZORT HIPLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 VAN BUREN ST STE 2602
NORMAN OK
73072-5609
US

IV. Provider business mailing address

1042 COUNTY STREET 2945
TUTTLE OK
73089-3125
US

V. Phone/Fax

Practice location:
  • Phone: 405-625-7579
  • Fax:
Mailing address:
  • Phone: 405-730-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: