Healthcare Provider Details

I. General information

NPI: 1619846797
Provider Name (Legal Business Name): EMMA YATES CLAYBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5139 WHITWORTH ST
MEMPHIS TN
38116-8436
US

IV. Provider business mailing address

5139 WHITWORTH ST
MEMPHIS TN
38116-8436
US

V. Phone/Fax

Practice location:
  • Phone: 901-653-7488
  • Fax: 901-653-7488
Mailing address:
  • Phone: 901-653-7488
  • Fax: 901-653-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1623
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1623
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: