Healthcare Provider Details

I. General information

NPI: 1114807138
Provider Name (Legal Business Name): HAILEE ANN RICKER MSAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W PORT PLZ FL DR6
SAINT LOUIS MO
63146-3011
US

IV. Provider business mailing address

26423 S HICKORY HILLS DR
HARRISONVILLE MO
64701-1673
US

V. Phone/Fax

Practice location:
  • Phone: 314-596-2656
  • Fax:
Mailing address:
  • Phone: 816-377-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2026043679
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: