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Active NPI 1174920821 Individual Practitioner Female Practitioner

Prudence Ticknor , RD

Dietitian, Registered • Modesto, CA

✓ Accepts Medicare Assignment Telehealth Available
Public Directory Information & Medical Disclaimer

This profile is compiled from official public domain records provided by CMS and the NPPES registry. TRUE-MEDINFO is an independent reference directory and does not provide medical advice, diagnosis, or treatment recommendations. Always consult a licensed medical professional for personal health decisions.

Professional Overview & Biography Verified Profile Summary

Prudence Ticknor, RD is a registered Dietitian, Registered practitioner in Modesto, CA. With approximately 29 years of clinical practice since completing medical education in 1997, Prudence Ticknor provides healthcare services at the registered practice location at 1552 COFFEE RD.

Prudence Ticknor is affiliated with Central California Bariatric Surgery A Medical Corporation and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include medical nutrition therapy, assessment and intervention, each, medical nutrition therapy performed in a group setting, each. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1552 Coffee Rd
Suite 200

Modesto, CA 953553122

Telephone 2092487168
Associated Practice Facility / Clinic

Medicare Profile & Education

Medical School

Other

Graduation Year

1997

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Dietitian, Registered in Modesto, CA

Senior Veteran Specialist (>20 Yrs)
Practitioner Clinical Experience
29 Yrs +12.7 yrs vs City Avg
City Avg: 16.3 Yrs
State Avg: 15.6 Yrs
Regional Practice Density
43 Specialists

Practicing in Modesto, CA (7235 Statewide)

Telehealth Adoption Rate
16.3% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount
43.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Ticknor (29 Years) 29 Yrs
Modesto Specialty Average (16.3 Years) 16.3 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2023)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
97802 Medical nutrition therapy, assessment and intervention, each 15 minutes
50 15 $50.00 $28.23

Medical Specialties & State Licenses

Dietitian, Registered Primary Specialty

NUCC Taxonomy Code: 133V00000X

State License NC 819773

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.

Hospital & Practice Group Affiliations

Central California Bariatric Surgery A Medical Corporation

1552 Coffee Rd, Modesto, CA 953553122

Phone: 2092487168151

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

14 Associated Practitioners
NPI 1073762217

Doctor of Medicine (M.D.)

Alyssa Martin , MSN, APRN, FNP-BC

Nurse Practitioner - Family

NPI 1114541117

Master of Science in Nursing, Advanced Practice Registered Nurse, Family Nurse Practitioner (Board Certified)

Marina Nguyen , NP

Nurse Practitioner - Family

NPI 1215645247

Nurse Practitioner

Neasha Mcmeo , FNP

Nurse Practitioner - Family

NPI 1306085436

Family Nurse Practitioner

NPI 1316388325

Doctor of Medicine (M.D.)

Dr. Felicia Agibi , PsyD

Psychologist - Clinical

NPI 1326547266

Doctor of Psychology (Psy.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
NPI Profile Active March 21, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location March 21, 2017

Registered at 1552 COFFEE RD, SUITE 200, MODESTO, CA 953553122 (Tel: 2092487168)

📍
Updated Business Mailing Address March 21, 2017

Registered at 1552 COFFEE RD, SUITE 200, MODESTO, CA 953553122 (Tel: 2092487168)

👤
Provider Name / Credentials Updated March 21, 2017

Recorded as PRUDENCE TICKNOR, RD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 21, 2017

Dietitian, Registered (License #819773 in NC)

NPI Profile Active November 24, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location November 24, 2014

Registered at 15 HIGHWAY 50, CAESARS HEALTH AND WELLNESS CENTER, STATELINE, NV 89449 (Tel: 7755865000)

📍
Updated Business Mailing Address November 24, 2014

Registered at PO BOX 8, 15 HIGHWAY 50, CAESARS HEALTH AND WELLNESS CENTER, STATELINE, NV 89449 (Tel: 7755865000)

👤
Provider Name / Credentials Updated November 24, 2014

Recorded as PRUDENCE TICKNOR, RD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 24, 2014

Dietitian, Registered (License #819773 in NC)

🟢
Initial NPI Registration & Enumeration November 24, 2014

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1174920821
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 24, 2014
Last Update: March 21, 2017
Sole Proprietor: Yes

Mailing Address

1552 Coffee Rd, Suite 200

Modesto, CA 953553122

Phone: 2092487168

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.