Provider Demographics
NPI:1588011126
Name:MOBLEY, EMILY CHRISTINE (RD CSP LD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CHRISTINE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:RD CSP LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 N JA TATE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1439
Mailing Address - Country:US
Mailing Address - Phone:513-237-2854
Mailing Address - Fax:
Practice Address - Street 1:1133 N JA TATE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1439
Practice Address - Country:US
Practice Address - Phone:513-237-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2906133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered