Shelly Denise Jack, BHRS CM II

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Practice address

1088 S Gin Rd
Atoka, OK 74525-7378

Phone

(580) 239-2071

Fax

(580) 509-5041

NPI assigned

Jan 11, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Shelly Denise Martin Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1447520135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 S OREGON AVE",
            "city": "ATOKA",
            "state": "OK",
            "postal_code": "745252879",
            "telephone_number": "580-230-3079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1088 S GIN RD",
            "city": "ATOKA",
            "state": "OK",
            "postal_code": "745257378",
            "telephone_number": "580-239-2071",
            "fax_number": "580-509-5041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "SHELLY",
        "middle_name": "DENISE",
        "name_prefix": "Ms.",
        "credential": "BHRS CM II",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-11",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "MARTIN",
            "middle_name": "DENISE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Joseph Reed Hutchings, APRN-CNP
• Inca Commnity Services, Inc.
• Dakota Alan Ingram
• Kristi Denise Jack
• Mickey Dewayne Jack, BHRS
• Shammi Jackson
• Vivian Jackson
• Jena M Jacobs I, BSW
• Sadie Jo Jacobsen
• James Pritchett DO

• Mental Health Clinic/Center (Including Community Mental Health Center) in Atoka, OK
• Providers in Atoka, OK by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.