25D2275016 CLIA NUMBER - CONSCIOUS CHANGE LLC

Laboratory Demographics

  • CLIA Code: 25D2275016
  • Facility Name: CONSCIOUS CHANGE LLC
  • Facility Address: 507 HERITAGE DR STE 101
    OXFORD, MS
    ZIP 38655
  • Facility Phone: 662 638-3388
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KRISNA A. HERVEY
  • NPI Number: 1275118036
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D2275016
LAB Type Physician Office
Facility Name CONSCIOUS CHANGE LLC
Street 507 HERITAGE DR STE 101
City OXFORD
State MS
ZIP 38655
Phone 662 638-3388
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2025
Certificate Expiration Date 1/12/2027
Facility Type Physician Office
Lab Director KRISNA A. HERVEY

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