Healthcare Provider Details

I. General information

NPI: 1366234023
Provider Name (Legal Business Name): MY CLINIC MEMPHIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 03/22/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 RALEIGH COMMON DR STE 100
MEMPHIS TN
38128-2478
US

IV. Provider business mailing address

4901 RALEIGH COMMON DR STE 100
MEMPHIS TN
38128-2478
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-4331
  • Fax:
Mailing address:
  • Phone: 901-545-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELISHEVA REESE
Title or Position: FAMILY NURSE PRACTITIONER / OWNER
Credential: MSN, APRN, FNP-BC
Phone: 901-545-4331