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18D2030174 CLIA NUMBER - CARRICO CONGLETON FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 18D2030174

Facility Name: CARRICO CONGLETON FAMILY PRACTICE

Facility Address:
2811 NEW HARTFORD ROAD, STE B
OWENSBORO, KY
ZIP 42303
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Facility Phone Number: 270 215-0234

Facility Type: Practitioner Other

Certificate Type: Waiver
NPI Number: 1750665162

Taxonomy: 363L00000X - Nurse Practitioner
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

CLIA Record

Field Name Field Value
CLIA Number 18D2030174
LAB Type Practitioner Other
Facility Name CARRICO CONGLETON FAMILY PRACTICE
Street 2811 NEW HARTFORD ROAD, STE B
City OWENSBORO
State KY
ZIP 42303
Phone 270 215-0234
CertificateType 4
CertificateEffectiveDate 9/22/2023
CertificateExpirationDate 9/21/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024