Charity M Lickfold, MFP, CPT, CNC

Primary specialty

Clinical Exercise PhysiologistTaxonomy code 224Y00000X

Practice address

580 NE Poplar St
Clatskanie, OR 97016-7470

Phone

(208) 704-7632

NPI assigned

Aug 31, 2020

Last updated

May 21, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1528671328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 555",
            "city": "CLATSKANIE",
            "state": "OR",
            "postal_code": "970160555",
            "telephone_number": "208-704-7632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 NE POPLAR ST",
            "city": "CLATSKANIE",
            "state": "OR",
            "postal_code": "970167470",
            "telephone_number": "208-704-7632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICKFOLD",
        "first_name": "CHARITY",
        "middle_name": "M",
        "credential": "MFP, CPT, CNC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-31",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "224Y00000X",
            "taxonomy_group": "",
            "desc": "Clinical Exercise Physiologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charity@fitandphatfitness.com",
            "affiliation": "N",
            "address_1": "580 NE Poplar St",
            "city": "Clatskanie",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970167470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Exercise Physiologist in Clatskanie, OR
• Providers in Clatskanie, OR by specialty
• Clinical Exercise Physiologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.