25D1060992 CLIA NUMBER - ENHANCED WELLNESS LIVING PLLC

Laboratory Demographics

  • CLIA Code: 25D1060992
  • Facility Name: ENHANCED WELLNESS LIVING PLLC
  • Facility Address: 115 W JACKSON STREET, SUITE 1E
    RIDGELAND, MS
    ZIP 39157
  • Facility Phone: 601 364-1132
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KELLY B. ENGELMANN
  • NPI Number: 1811098866
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D1060992
LAB Type Practitioner Other
Facility Name ENHANCED WELLNESS LIVING PLLC
Street 115 W JACKSON STREET, SUITE 1E
City RIDGELAND
State MS
ZIP 39157
Phone 601 364-1132
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/7/2024
Certificate Expiration Date 11/6/2026
Facility Type Practitioner Other
Lab Director KELLY B. ENGELMANN

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