04D2194476 CLIA NUMBER - VITAL WELLNESS CLINIC

Laboratory Demographics

  • CLIA Code: 04D2194476
  • Facility Name: VITAL WELLNESS CLINIC
  • Facility Address: 4001 COMMERCIAL DR, STE 1
    MARION, AR
    ZIP 72364
  • Facility Phone: 870 636-9218
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KRISTY A. WHITED
  • NPI Number: 1013528017
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 04D2194476
LAB Type Practitioner Other
Facility Name VITAL WELLNESS CLINIC
Street 4001 COMMERCIAL DR, STE 1
City MARION
State AR
ZIP 72364
Phone 870 636-9218
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Practitioner Other
Lab Director KRISTY A. WHITED

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This page was last updated on: 9/29/2025