04D2275410 CLIA NUMBER - DELTA FAMILY CLINIC

Laboratory Demographics

  • CLIA Code: 04D2275410
  • Facility Name: DELTA FAMILY CLINIC
  • Facility Address: 1111 N WASHINGTON ST
    FORREST CITY, AR
    ZIP 72335
  • Facility Phone: 870 594-8012
  • Facility Type: Other - FNP PRIMARY CARE CLINIC
  • Facility Type: Waiver
  • Lab Director: SAMANTHA DEVAZIER
  • NPI Number: 1942915517
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 04D2275410
LAB Type Other - FNP PRIMARY CARE CLINIC
Facility Name DELTA FAMILY CLINIC
Street 1111 N WASHINGTON ST
City FORREST CITY
State AR
ZIP 72335
Phone 870 594-8012
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2025
Certificate Expiration Date 1/19/2027
Facility Type Other - FNP PRIMARY CARE CLINIC
Lab Director SAMANTHA DEVAZIER

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