Provider Demographics
NPI:1902649932
Name:TAWNEY, CLARENCE DAVID (RD, LD)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:DAVID
Last Name:TAWNEY
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-2384
Mailing Address - Country:US
Mailing Address - Phone:540-599-5055
Mailing Address - Fax:304-487-7693
Practice Address - Street 1:109 MORRISON DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2322
Practice Address - Country:US
Practice Address - Phone:304-487-7639
Practice Address - Fax:304-487-7693
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1517133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered