04D2286790 CLIA NUMBER - PHILLIPS MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 04D2286790
  • Facility Name: PHILLIPS MEDICAL CLINIC
  • Facility Address: 613 LEXINGTON AVENUE
    FORT SMITH, AR
    ZIP 72901
  • Facility Phone: 479 242-9797
  • Facility Type: Other - FAMILY NURSE PRACTITIONER
  • Facility Type: Waiver
  • Lab Director: JACQUELINE G. PHILLIPS
  • NPI Number: 1427736024
  • Taxonomy: 363LF0000X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2286790
LAB Type Other - FAMILY NURSE PRACTITIONER
Facility Name PHILLIPS MEDICAL CLINIC
Street 613 LEXINGTON AVENUE
City FORT SMITH
State AR
ZIP 72901
Phone 479 242-9797
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2025
Certificate Expiration Date 8/2/2027
Facility Type Other - FAMILY NURSE PRACTITIONER
Lab Director JACQUELINE G. PHILLIPS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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