Active NPI
Candice O'Hare, MS, RD
- Registered Dietitian
- Jackson, MO
National Provider Identifier
1134576267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2008029879
- Practice address
- 1217 Chamberlain Dr
Jackson, MO 63755-2940 - Phone
- (573) 934-5572
- NPI assigned
- May 18, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2008029879 | MO | Primary |
Addresses
Primary practice location
1217 Chamberlain Dr
Jackson, MO 63755-2940
Mailing address
1217 Chamberlain Dr
Jackson, MO 63755-2940
Phone (573) 934-5572
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13826318 | Other | MO | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2008029879 | MO | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463529600000",
"number": "1134576267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1217 CHAMBERLAIN DR",
"city": "JACKSON",
"state": "MO",
"postal_code": "637552940",
"telephone_number": "573-934-5572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1217 CHAMBERLAIN DR",
"city": "JACKSON",
"state": "MO",
"postal_code": "637552940",
"telephone_number": "573-934-5572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'HARE",
"first_name": "CANDICE",
"credential": "MS, RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-18",
"last_updated": "2016-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MO",
"license": "2008029879",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "13826318",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.