Provider Demographics
NPI:1619846797
Name:CLAYBORNE, EMMA YATES
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:YATES
Last Name:CLAYBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 WHITWORTH ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-8436
Mailing Address - Country:US
Mailing Address - Phone:901-653-7488
Mailing Address - Fax:901-653-7488
Practice Address - Street 1:5139 WHITWORTH ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8436
Practice Address - Country:US
Practice Address - Phone:901-653-7488
Practice Address - Fax:901-653-7488
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1623133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal