04D2247184 CLIA NUMBER - JACKSON COUNTY WELLNESS AND SCREENING

Laboratory Demographics

  • CLIA Code: 04D2247184
  • Facility Name: JACKSON COUNTY WELLNESS AND SCREENING
  • Facility Address: 1 DUDLEY CIRCLE
    NEWPORT, AR
    ZIP 72112
  • Facility Phone: 870 512-8242
  • Facility Type: Health Fair
  • Facility Type: Waiver
  • Lab Director: MS. RETHA DUDLEY
  • NPI Number: 1720406739
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2247184
LAB Type Health Fair
Facility Name JACKSON COUNTY WELLNESS AND SCREENING
Street 1 DUDLEY CIRCLE
City NEWPORT
State AR
ZIP 72112
Phone 870 512-8242
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/5/2024
Certificate Expiration Date 1/4/2026
Facility Type Health Fair
Lab Director MS. RETHA DUDLEY

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