MEDICARE: MY CLINIC MEMPHIS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1100X	Research Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1366234023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY CLINIC MEMPHIS, LLC

Provider Business Mailing Address
First Line	:	4901 RALEIGH COMMON DR STE 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2478
Country	:	US
Telephone Number	:	901-545-4331
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 RALEIGH COMMON DR STE 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2478
Country	:	US
Telephone Number	:	901-545-4331
Fax Number	:

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

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	03/22/2026

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