Individual
NICHOLAS KYLE SHOCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
10012 KENNERLY RD STE 406, SAINT LOUIS, MO 63128-2197
(314) 525-1224
(314) 525-4957
Mailing address
10012 KENNERLY RD STE 406, SAINT LOUIS, MO 63128-2197
(314) 525-1224
(314) 525-4957
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209017506
IL
363LF0000X
Family Nurse Practitioner
Primary
2021027097
MO
363LF0000X
Family Nurse Practitioner
209.017506
IL
Other
Enumeration date
07/06/2018
Last updated
04/29/2026
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