Provider Demographics
NPI:1063762631
Name:MORRELL, CLARA R (MS RD LDN)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:R
Last Name:MORRELL
Suffix:
Gender:F
Credentials:MS 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 1:2025 PENDRAGON RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3432
Mailing Address - Country:US
Mailing Address - Phone:276-690-5316
Mailing Address - Fax:
Practice Address - Street 1:2025 PENDRAGON RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3432
Practice Address - Country:US
Practice Address - Phone:276-690-5316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2799133V00000X
WV1345133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered