Active NPI
Carly Fenimore, M.S., R.D., L.D.N.
- Registered Dietitian
- Charlotte, NC
National Provider Identifier
1962800185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L003946
- Practice address
- 9209 Baybrook LN
Charlotte, NC 28277-3576 - Phone
- (704) 591-0701
- NPI assigned
- Dec 22, 2014
- 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 | L003946 | NC | Primary |
Addresses
Primary practice location
9209 Baybrook LN
Charlotte, NC 28277-3576
Mailing address
715 Conestoga Dr
Charlotte, NC 28270-0832
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 |
|---|---|---|---|
| L003946 | NC | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fertility Rd, LLC | Dietitian, Registered | Current | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419206400000",
"number": "1962800185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "715 CONESTOGA DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282700832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9209 BAYBROOK LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282773576",
"telephone_number": "704-591-0701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENIMORE",
"first_name": "CARLY",
"name_prefix": "Mrs.",
"credential": "M.S., R.D., L.D.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-22",
"last_updated": "2014-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L003946",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.