Active NPI
Candise Jordan Fenton, R.D.
- Registered Dietitian
- Colorado Springs, CO
National Provider Identifier
1720369085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1061751
- Practice address
- 2506 Balboa St
Colorado Springs, CO 80907-6934 - Phone
- (719) 425-5793
- NPI assigned
- Aug 31, 2011
- Last updated
- Aug 31, 2011
- Sex
- Female
- Sole proprietor
- No
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 | 1061751 | AL | Primary |
Addresses
Primary practice location
2506 Balboa St
Colorado Springs, CO 80907-6934
Mailing address
2506 Balboa St
Colorado Springs, CO 80907-6934
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1061751 | AL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314748800000",
"number": "1720369085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2506 BALBOA ST",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809076934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2506 BALBOA ST",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809076934",
"telephone_number": "719-425-5793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENTON",
"first_name": "CANDISE",
"middle_name": "JORDAN",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-31",
"last_updated": "2011-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AL",
"license": "1061751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.