MEDICARE: COURTNEY LYNN SHOCKLEY APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2522290	MN
2	363LF0000X	Family Nurse Practitioner	2026005061	MO
3	163W00000X	Registered Nurse	2016006219	MO

General Provider Information

NPI Number	:	1376406736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY LYNN SHOCKLEY APRN

Provider Business Mailing Address
First Line	:	660 S EUCLID AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1010
Country	:	US
Telephone Number	:	314-362-6908
Fax Number	:

Provider Business Practice Location Address
First Line	:	3965 LACLEDE AVE APT 310
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3283
Country	:	US
Telephone Number	:	314-448-0515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	03/18/2026

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