Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicholas Kyle Shockley, FNP

Individual provider Family Nurse Practitioner · NPI 1649766288

Nicholas Kyle Shockley, FNP is a Nurse Practitioner in Saint Louis, Missouri. Qualified in 2018, 8 years ago. Practices with Southern Illinois Medical Services Nfp, a 332-clinician group and accepts Medicare assignment. Licensed in Illinois and Missouri.

Years since qualifying
8
Licensed in
IL, MO
In the registry since
2018
Specialties on file
3
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

10012 Kennerly Rd Ste 406
Saint Louis, MO 63128-2197
Phone: (314) 525-1224
Fax: (314) 525-4957
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 2021027097 (MO)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 209.017506 (IL)
Nurse Practitioner Taxonomy 363L00000X · Licence 209017506 (IL)

Record details

NPI number1649766288
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP
Sole proprietorNo
NPI enumeratedJuly 6, 2018
Last updated in NPPESApril 29, 2026
Certification dateApril 29, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Southern Illinois Medical Services Nfp — 332 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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