Individual
MRS. LOGAN JAY SHOCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1060 W 10TH ST, ROLLA, MO 65401-2905
(855) 406-3324
(573) 458-8363
Mailing address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
(573) 426-2108
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2016022013
MO
363LF0000X
Family Nurse Practitioner
Primary
2020003116
MO
Other
Enumeration date
12/24/2019
Last updated
03/20/2025
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