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General NPI Number Information
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NPI Number | 1376406736
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Entity Type | Individual
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Provider Name | COURTNEY LYNN SHOCKLEY
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 3965 LACLEDE AVE APT 310
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3283
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Country | US
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Telephone | 314-448-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 3965 LACLEDE AVE APT 310
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3283
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Country | US
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Telephone | 314-448-0515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2522290
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2016006219
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License Number State | MO
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