Active NPI
Shelli Shultz Jackson, PH.D.
- Psychologist
- Norman, OK
National Provider Identifier
1033129010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 922
- Practice address
- 2500 Boardwalk Ste 203
Norman, OK 73069-6593 - Phone
- (405) 329-8501
- Fax
- (405) 253-0581
- NPI assigned
- Aug 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 922 | OK | Primary |
Addresses
Primary practice location
2500 Boardwalk Ste 203
Norman, OK 73069-6593
Mailing address
2500 Boardwalk Ste 203
Norman, OK 73069-6593
Phone (405) 329-8501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100839280A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 922 | OK | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639699200000",
"number": "1033129010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 BOARDWALK STE 203",
"city": "NORMAN",
"state": "OK",
"postal_code": "730696593",
"telephone_number": "405-329-8501",
"fax_number": "405-253-0581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 BOARDWALK STE 203",
"city": "NORMAN",
"state": "OK",
"postal_code": "730696593",
"telephone_number": "405-329-8501",
"fax_number": "405-253-0581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHELLI",
"middle_name": "SHULTZ",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-09",
"last_updated": "2021-12-17",
"certification_date": "2021-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OK",
"license": "922",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100839280A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Norman, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.