Provider Demographics
NPI:1821719709
Name:COCKRUM, SHELBI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:
Last Name:COCKRUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:SHELBI
Other - Middle Name:
Other - Last Name:COCKRUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-1118
Mailing Address - Country:US
Mailing Address - Phone:417-847-1111
Mailing Address - Fax:
Practice Address - Street 1:1101 MAIN ST
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-1118
Practice Address - Country:US
Practice Address - Phone:417-847-1111
Practice Address - Fax:417-554-8660
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002036024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily