45D2152640 CLIA NUMBER - KEY DERMATOLOGY PLLC

Laboratory Demographics

  • CLIA Code: 45D2152640
  • Facility Name: KEY DERMATOLOGY PLLC
  • Facility Address: 4949 GOLDEN TRIANGLE BLVD SUITE 611
    FORT WORTH, TX
    ZIP 76244
  • Facility Phone: 817 898-2188
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JULIE NGUYEN
  • NPI Number: 1629565544
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 45D2152640
LAB Type Physician Office
Facility Name KEY DERMATOLOGY PLLC
Street 4949 GOLDEN TRIANGLE BLVD SUITE 611
City FORT WORTH
State TX
ZIP 76244
Phone 817 898-2188
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/14/2024
Certificate Expiration Date 8/13/2026
Facility Type Physician Office
Lab Director JULIE NGUYEN

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