04D2292302 CLIA NUMBER - DYNAMIC MED

Laboratory Demographics

  • CLIA Code: 04D2292302
  • Facility Name: DYNAMIC MED
  • Facility Address: 1010 NORTH DUDNEY, SUITE C
    MAGNOLIA, AR
    ZIP 71753
  • Facility Phone: 870 234-2675
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: SHAWNTEL M. PRICE
  • NPI Number: 1306522792
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 04D2292302
LAB Type Practitioner Other
Facility Name DYNAMIC MED
Street 1010 NORTH DUDNEY, SUITE C
City MAGNOLIA
State AR
ZIP 71753
Phone 870 234-2675
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/24/2023
Certificate Expiration Date 10/23/2025
Facility Type Practitioner Other
Lab Director SHAWNTEL M. PRICE

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