1. Home
  2. Directory
  3. California
  4. Modesto
  5. Dietitian Registered
  6. NPI Profile

PRUDENCE TICKNOR RD
NPI 1174920821
Dietitian, Registered in Modesto, CA

Active since November 24, 2014Accepts Medicare Assignment
1552 COFFEE RD, SUITE 200, MODESTO, CA 95355(209) 248-7168 Get Directions Write a Review

NPPES record last updated: March 21, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Prudence Ticknor Rd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRUDENCE TICKNOR RD (NPI 1174920821) is an individual dietitian, registered in Modesto, California, licensed in North Carolina (819773) and active in the NPI registry since November 2014. She is a graduate of Other (1997).

NPPES Registry Identity

NPI1174920821
Entity TypeIndividualFemale
Primary Taxonomy133V00000X
Provider Legal NamePRUDENCE TICKNORCredential: RD
Location Address1552 COFFEE RD, SUITE 200Modesto, CA 95355-3122
Mailing Address1552 Coffee Rd, Suite 200Modesto, CA 95355-3122 · (209) 248-7168
Phone(209) 248-7168
Sole ProprietorYes
Medical School CMSOtherGraduated 1997
Enumeration DateNovember 24, 2014
Last NPPES UpdateMarch 21, 2017
✔ NPI 1174920821 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers
Taxonomy Code133V00000X
License✔ Licensed in NC · 819773
Definition
A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
1552 COFFEE RD, Modesto, CA 95355
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Prudence Ticknor Rd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4688938483
PECOS Enrollment IDI20180502002366

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95355 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $58.87 – $176.60
Typical copayment $0.00 (range $14.71 – $44.15)
Most-billed visit code NA
Established Patient
$103.36 typical visit price
range $19.28 – $144.60
Typical copayment $25.84 (range $4.82 – $36.15)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. PAM SUE GRASSMIDT RNC
Nurse Practitioner (Adult Health)
1552 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 521-4372
STEPHEN K LIU MD PROFESSIONAL CORPORATION
Radiology (Vascular & Interventional Radiology)
1552 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 524-2333
MATTHEW LAURENCE TILSTRA MD
Obstetrics & Gynecology
1552 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 521-4372
STEPHEN KAO LIU M.D.
Radiology (Vascular & Interventional Radiology)
1552 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 524-2333
DR. ESTHER JUNE TOW-DER M.D.
Obstetrics & Gynecology
1552 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 521-4372
DR. NICHOLAS HOLT HOPKINS MD
Obstetrics & Gynecology
1552 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 521-4372
DR. JAMES YUEN KUEN YIP M.D.
Obstetrics & Gynecology
1552 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 521-4372
ADRIENNE MICHELLE RIVERA NP
Nurse Practitioner
1552 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 521-4372

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Prudence Ticknor's NPI number?

The NPI number for Prudence Ticknor is 1174920821. It was assigned to this individual provider in the NPPES registry on November 24, 2014.

Where is Prudence Ticknor located?

Prudence Ticknor practices at 1552 Coffee Rd Suite 200, Modesto, CA 95355. The listed phone number is (209) 248-7168.

What is Prudence Ticknor's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Prudence Ticknor enrolled in Medicare?

Yes. Prudence Ticknor is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Prudence Ticknor was last updated on March 21, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.