18D2099625 CLIA NUMBER - KENTUCKYCARE #112

Laboratory Demographics

  • CLIA Code: 18D2099625
  • Facility Name: KENTUCKYCARE #112
  • Facility Address: 120 NORTH FOURTH STREET
    BARLOW, KY
    ZIP 42024
  • Facility Phone: 270 334-3131
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: MS. KRISTINE M. PRUITT
  • NPI Number: 1194263236
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2099625
LAB Type Federally Qualified Health Center
Facility Name KENTUCKYCARE #112
Street 120 NORTH FOURTH STREET
City BARLOW
State KY
ZIP 42024
Phone 270 334-3131
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
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