Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Prudence Ticknor, RD

Individual provider Registered Dietitian · NPI 1174920821

Prudence Ticknor, RD is a Registered Dietitian OR Nutrition Professional in Modesto, California. Qualified in 1997, 29 years ago. Practices with Central California Bariatric Surgery a Medical Corporation, an 11-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
29
Licensed in
NC
In the registry since
2014
What do these letters mean?
RD — Registered Dietitian
A credentialed nutrition professional.

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Practice location Address checks out

1552 Coffee Rd Ste 200
Modesto, CA 95355-3122
Phone: (209) 248-7168
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X · Licence 819773 (NC)

Record details

NPI number1174920821
Entity typeIndividual (Type 1)
GenderFemale
Credentials RD
Sole proprietorYes
NPI enumeratedNovember 24, 2014
Last updated in NPPESMarch 21, 2017
Mailing address1552 Coffee Rd, Suite 200, Modesto, CA 95355-3122

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyREGISTERED DIETITIAN OR NUTRITION PROFESSIONAL
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Group practice Central California Bariatric Surgery A Medical Corporation — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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