{
"Npi": {
"NPI": "1366234023",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MY CLINIC MEMPHIS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4901 RALEIGH COMMON DR STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MEMPHIS",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38128-2478",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-545-4331",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4901 RALEIGH COMMON DR STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MEMPHIS",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38128-2478",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-545-4331",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/20/2025",
"LastUpdateDate": "05/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REESE",
"AuthorizedOfficialFirstName": "ELISHEVA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "FAMILY NURSE PRACTITIONER / OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MSN, APRN, FNP-BC",
"AuthorizedOfficialTelephoneNumber": "901-545-4331",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QR1100X",
"TaxonomyName": "Research Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}