Healthcare Provider Details

I. General information

NPI: 1295355964
Provider Name (Legal Business Name): SARAH EMILY JANE HEYRMAN RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 775-502-6659
  • Fax:
Mailing address:
  • Phone: 901-545-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3019
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: