25D2293540 CLIA NUMBER - OLE BROOK KIDS PC

Laboratory Demographics

  • CLIA Code: 25D2293540
  • Facility Name: OLE BROOK KIDS PC
  • Facility Address: 301-C HWY 51S
    BROOKHAVEN, MS
    ZIP 39601
  • Facility Phone: 601 835-1062
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KAYLA D. THURMAN
  • NPI Number: 1649051046
  • Taxonomy: 363LP0200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D2293540
LAB Type Practitioner Other
Facility Name OLE BROOK KIDS PC
Street 301-C HWY 51S
City BROOKHAVEN
State MS
ZIP 39601
Phone 601 835-1062
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Practitioner Other
Lab Director KAYLA D. THURMAN

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