04D2211170 CLIA NUMBER - VIVIEN TUCKER MD

Laboratory Demographics

  • CLIA Code: 04D2211170
  • Facility Name: VIVIEN TUCKER MD
  • Facility Address: 13859 GREENRIDGE DRIVE
    FAYETTEVILLE, AR
    ZIP 72701
  • Facility Phone: 812 455-8405
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: DR. VIVIEN TUCKER
  • NPI Number: 1821049925
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2211170
LAB Type Independent
Facility Name VIVIEN TUCKER MD
Street 13859 GREENRIDGE DRIVE
City FAYETTEVILLE
State AR
ZIP 72701
Phone 812 455-8405
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2025
Certificate Expiration Date 1/25/2027
Facility Type Independent
Lab Director DR. VIVIEN TUCKER

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