Provider Demographics
NPI:1174316558
Name:NEES, SHELBY RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:RENEE
Last Name:NEES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 E STATE ROAD 42
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:IN
Mailing Address - Zip Code:46120-9410
Mailing Address - Country:US
Mailing Address - Phone:765-720-9532
Mailing Address - Fax:
Practice Address - Street 1:1765 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1296
Practice Address - Country:US
Practice Address - Phone:309-661-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085011271363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical