Provider Demographics
NPI:1366234023
Name:MY CLINIC MEMPHIS
Entity type:Organization
Organization Name:MY CLINIC MEMPHIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISHEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC
Authorized Official - Phone:901-545-4331
Mailing Address - Street 1:4901 RALEIGH COMMON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2478
Mailing Address - Country:US
Mailing Address - Phone:901-545-4331
Mailing Address - Fax:
Practice Address - Street 1:4901 RALEIGH COMMON DR STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2478
Practice Address - Country:US
Practice Address - Phone:901-545-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch