Provider Demographics
NPI:1063762631
Name:MORRELL, CLARA R (RD LDN)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:R
Last Name:MORRELL
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:J
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-1000
Mailing Address - Fax:
Practice Address - Street 1:1098 S MAYO TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1546
Practice Address - Country:US
Practice Address - Phone:606-218-1000
Practice Address - Fax:606-433-1867
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered