Provider Demographics
NPI:1275882060
Name:MORGAN, SHAY (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:SHAY
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 EAST POPLAR STREET, PO BOX 738
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830
Mailing Address - Country:US
Mailing Address - Phone:479-754-5328
Mailing Address - Fax:479-754-5470
Practice Address - Street 1:1100 EAST POPLAR STREET
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830
Practice Address - Country:US
Practice Address - Phone:479-754-5328
Practice Address - Fax:479-754-5470
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered