25D2302685 CLIA NUMBER - EXCELLENCE CONCIERGE MEDICINE

Laboratory Demographics

  • CLIA Code: 25D2302685
  • Facility Name: EXCELLENCE CONCIERGE MEDICINE
  • Facility Address: 7712 KERI COVE
    OLIVE BRANCH, MS
    ZIP 38654
  • Facility Phone: 901 501-5240
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MIRANDA D. WHITE
  • NPI Number: 1124718366
  • Taxonomy: 363LC1500X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D2302685
LAB Type Practitioner Other
Facility Name EXCELLENCE CONCIERGE MEDICINE
Street 7712 KERI COVE
City OLIVE BRANCH
State MS
ZIP 38654
Phone 901 501-5240
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2024
Certificate Expiration Date 4/14/2026
Facility Type Practitioner Other
Lab Director MIRANDA D. WHITE

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