18D2316448 CLIA NUMBER - EVOLUTION PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 18D2316448
  • Facility Name: EVOLUTION PRIMARY CARE
  • Facility Address: 1102 TRIPLETT ST SUITE 2100
    OWENSBORO, KY
    ZIP 42303
  • Facility Phone: 270 238-6468
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JAMIE E. DURHAM
  • NPI Number: 1487471215
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 18D2316448
LAB Type Practitioner Other
Facility Name EVOLUTION PRIMARY CARE
Street 1102 TRIPLETT ST SUITE 2100
City OWENSBORO
State KY
ZIP 42303
Phone 270 238-6468
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Practitioner Other
Lab Director JAMIE E. DURHAM

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