04D2283750 CLIA NUMBER - SKIN DERMATOLOGY PRACTITIONER, PLLC

Laboratory Demographics

  • CLIA Code: 04D2283750
  • Facility Name: SKIN DERMATOLOGY PRACTITIONER, PLLC
  • Facility Address: 3106 SOUTHWEST DRIVE, SUITE 103
    JONESBORO, AR
    ZIP 72404
  • Facility Phone: 870 641-7546
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: NANCY PEMBERTON
  • NPI Number: 1003505389
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 04D2283750
LAB Type Physician Office
Facility Name SKIN DERMATOLOGY PRACTITIONER, PLLC
Street 3106 SOUTHWEST DRIVE, SUITE 103
City JONESBORO
State AR
ZIP 72404
Phone 870 641-7546
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 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Physician Office
Lab Director NANCY PEMBERTON

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