18D2032641 CLIA NUMBER - KENTUCKYCARE 21

Laboratory Demographics

  • CLIA Code: 18D2032641
  • Facility Name: KENTUCKYCARE 21
  • Facility Address: 75 EAST COURT STREET
    BARDWELL, KY
    ZIP 42023
  • Facility Phone: 270 628-3333
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: MS. KRISTINE M. PRUITT
  • NPI Number: 1669765038
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2032641
LAB Type Federally Qualified Health Center
Facility Name KENTUCKYCARE 21
Street 75 EAST COURT STREET
City BARDWELL
State KY
ZIP 42023
Phone 270 628-3333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/10/2023
Certificate Expiration Date 11/9/2025
Facility Type Federally Qualified Health Center
Lab Director MS. KRISTINE M. PRUITT

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