Healthcare Provider Details

I. General information

NPI: 1700794708
Provider Name (Legal Business Name): MS. JENNIFER L. HIXSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S VANN ST
PRYOR OK
74361-3613
US

IV. Provider business mailing address

205 NE 4TH ST
PRYOR OK
74361-2415
US

V. Phone/Fax

Practice location:
  • Phone: 918-760-2768
  • Fax:
Mailing address:
  • Phone: 918-760-2768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number199160
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: