19D2198806 CLIA NUMBER - JACKSON STREET PEDIATRICS, LLC

Laboratory Demographics

  • CLIA Code: 19D2198806
  • Facility Name: JACKSON STREET PEDIATRICS, LLC
  • Facility Address: 5716 JACKSON STREET
    ALEXANDRIA, LA
    ZIP 71303
  • Facility Phone: 318 767-5603
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KAI WICKER-BROWN
  • NPI Number: 1205454774
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 19D2198806
LAB Type Physician Office
Facility Name JACKSON STREET PEDIATRICS, LLC
Street 5716 JACKSON STREET
City ALEXANDRIA
State LA
ZIP 71303
Phone 318 767-5603
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Physician Office
Lab Director KAI WICKER-BROWN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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