Provider Demographics
NPI:1457039349
Name:WALKER, RYAN STEWART (RN)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:STEWART
Last Name:WALKER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17102 S SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-8018
Mailing Address - Country:US
Mailing Address - Phone:816-588-1669
Mailing Address - Fax:
Practice Address - Street 1:17102 S SCOTT RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-8018
Practice Address - Country:US
Practice Address - Phone:916-588-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1635749163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy