Provider Demographics
NPI:1841372349
Name:VENTERS-JACOBS, SHELLY L (MD)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:L
Last Name:VENTERS-JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:LAURA
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6424 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2012
Mailing Address - Country:US
Mailing Address - Phone:405-757-4643
Mailing Address - Fax:
Practice Address - Street 1:220 S LITTLER AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3856
Practice Address - Country:US
Practice Address - Phone:405-757-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18018207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5806340002Medicare NSC