17D2193392 CLIA NUMBER - TAPESTRY PSYCHIATRIC SERVICE

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Laboratory Demographics

CLIA Number: 17D2193392

Facility Name: TAPESTRY PSYCHIATRIC SERVICE

Facility Address:
504 N KANSAS AVENUE, STE B-1
LIBERAL, KS
ZIP 67901
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Facility Phone Number: 620 604-5274

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1316300239

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	17D2193392
LAB Type	Practitioner Other
Facility Name	TAPESTRY PSYCHIATRIC SERVICE
Street	504 N KANSAS AVENUE, STE B-1
City	LIBERAL
State	KS
ZIP	67901
Phone	620 604-5274
CertificateType	4
CertificateEffectiveDate	9/21/2022
CertificateExpirationDate	9/20/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024