Shelly Jacobs MD PLLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

SHELLY JACOBS MD PLLC

Doing business as

Suboxone and Wellness Clinic

Practice address

6424 N Portland Ave
Oklahoma City, OK 73116-2012

Phone

(405) 757-4643

NPI assigned

Sep 12, 2022

Organization subpart

No

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

Authorized official

Name

Khang Truong

Title

Business Manager

Phone

(405) 532-3176

Specialties & licenses 1

Addresses

Other names 1

• Suboxone and Wellness Clinic Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shelly L Venters-Jacobs, MD

  • Addiction Medicine (Internal Medicine) Physician
  • Edmond, OK
  • NPI 1841372349
  NPD

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1770204364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6424 N PORTLAND AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731162012",
            "telephone_number": "405-757-4643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 N PORTLAND AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731162012",
            "telephone_number": "405-757-4643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELLY JACOBS MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "TRUONG",
        "authorized_official_first_name": "KHANG",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "405-532-3176"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suboxone and Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Julie Shelley, D.O.
• Latina D Shelley, APRN, CPNP-PC
• Ralisha Revelyn Shelley
• Breanna Leigh Shellhorse
• Brent Alan Shellman, P.T.
• Alexis Shelton, APRN, FNP-C
• Brenda Shelton
• Bryan Shelton
• Christopher Wyatt Shelton
• Darice Shelton, BA

• Substance Abuse Rehabilitation Facility in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Substance Abuse Rehabilitation Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.