Healthcare Provider Details

I. General information

NPI: 1437011673
Provider Name (Legal Business Name): RILEY L WALKER MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MADISON ST FL 2
JEFFERSON CITY MO
65101-5227
US

IV. Provider business mailing address

3806 CROCODILE DR
COLUMBIA MO
65202-1511
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-4860
  • Fax:
Mailing address:
  • Phone: 636-775-5983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2026024267
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: