19D2325807 CLIA NUMBER - PEGASUS PRIMARY PROVIDERS, LLC

Laboratory Demographics

  • CLIA Code: 19D2325807
  • Facility Name: PEGASUS PRIMARY PROVIDERS, LLC
  • Facility Address: 4624 CYPRESS ST SUITE 7
    WEST MONROE, LA
    ZIP 71291
  • Facility Phone: 318 914-8150
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GLENDA S. PEVETO
  • NPI Number: 1982486395
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 19D2325807
LAB Type Physician Office
Facility Name PEGASUS PRIMARY PROVIDERS, LLC
Street 4624 CYPRESS ST SUITE 7
City WEST MONROE
State LA
ZIP 71291
Phone 318 914-8150
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2025
Certificate Expiration Date 6/19/2027
Facility Type Physician Office
Lab Director GLENDA S. PEVETO

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