Provider Demographics
NPI:1710560628
Name:LIKES, SHELBY ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ELIZABETH
Last Name:LIKES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:ELIZABETH
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:503 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-9307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-1100
Practice Address - Country:US
Practice Address - Phone:573-717-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021015301363L00000X
MO2016021485163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420137853Medicaid