Dake R Walden, ATC
Individual provider Active NPI Athletic Trainer · Earth City, MO
NPI 1124155890 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124155890
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 110382 (MO)
- Practice address
- 1 Rams Way
Earth City, MO 63045-1523 - Phone
- (314) 516-8735
- Fax
- (314) 516-8777
- NPI assigned
- Feb 28, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110382 | MO | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 110382 | MO | Yes |
Addresses
Primary practice location
1 Rams Way
Earth City, MO 63045-1523
Mailing address
1 Rams Way
Earth City, MO 63045-1523
Phone (314) 516-8735
Other providers in Earth City, MO
- Kevin Joseph Stock
- Jill Everly Thompson
- Nida Vasant Trapp
- United Seating and Mobility LLC
- Unity Health Medscript Inc
- Allison Marie Watson
- Dennis Wentzel
- Wheelchair Professionals LLC
- Tyler Williams
All providers in Earth City, MO · Athletic Trainer in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.