04D2154028 CLIA NUMBER - ARCARE 111

Laboratory Demographics

  • CLIA Code: 04D2154028
  • Facility Name: ARCARE 111
  • Facility Address: 1400 BRADEN
    JACKSONVILLE, AR
    ZIP 72076
  • Facility Phone: 501 241-1676
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. KRISTINE M. PRUITT
  • NPI Number: 1760963516
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2154028
LAB Type Federally Qualified Health Center
Facility Name ARCARE 111
Street 1400 BRADEN
City JACKSONVILLE
State AR
ZIP 72076
Phone 501 241-1676
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2024
Certificate Expiration Date 9/4/2026
Facility Type Federally Qualified Health Center
Lab Director DR. KRISTINE M. PRUITT

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