Healthcare Provider Details

I. General information

NPI: 1710560628
Provider Name (Legal Business Name): SHELBY ELIZABETH LIKES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY ELIZABETH BACON

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W COMMERCIAL ST
KENNETT MO
63857-1100
US

IV. Provider business mailing address

503 N 12TH AVE
OZARK MO
65721-9307
US

V. Phone/Fax

Practice location:
  • Phone: 573-717-1072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2021015301
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2016021485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: