18D2290893 CLIA NUMBER - KENTUCKYCARE 58

Laboratory Demographics

  • CLIA Code: 18D2290893
  • Facility Name: KENTUCKYCARE 58
  • Facility Address: 2006 HOLIDAY LANE
    FULTON, KY
    ZIP 42041
  • Facility Phone: 270 413-1001
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: MS. KRISTINE M. PRUITT
  • NPI Number: 1174771018
  • Taxonomy: 261QS1200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2290893
LAB Type Federally Qualified Health Center
Facility Name KENTUCKYCARE 58
Street 2006 HOLIDAY LANE
City FULTON
State KY
ZIP 42041
Phone 270 413-1001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2025
Certificate Expiration Date 10/2/2027
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