=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619846797
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMMA YATES CLAYBORNE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2025
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5139 WHITWORTH ST
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38116-8436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-653-7488
-----------------------------------------------------
Fax | 901-653-7488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5139 WHITWORTH ST
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38116-8436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-653-7488
-----------------------------------------------------
Fax | 901-653-7488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133VN1005X
-----------------------------------------------------
Taxonomy Name | Renal Nutrition Registered Dietitian
-----------------------------------------------------
License Number | 1623
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 1623
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------