45D1003488 CLIA NUMBER - KELLEY MOON, MD

Laboratory Demographics

  • CLIA Code: 45D1003488
  • Facility Name: KELLEY MOON, MD
  • Facility Address: 1320 NORTH UNIVERSITY STE B
    NACOGDOCHES, TX
    ZIP 75961
  • Facility Phone: 936 559-9225
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KELLEY E. MOON
  • NPI Number: 1255366035
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D1003488
LAB Type Physician Office
Facility Name KELLEY MOON, MD
Street 1320 NORTH UNIVERSITY STE B
City NACOGDOCHES
State TX
ZIP 75961
Phone 936 559-9225
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/19/2025
Certificate Expiration Date 2/18/2027
Facility Type Physician Office
Lab Director KELLEY E. MOON

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