# PATHOLOGY SERVICES LABORATORY PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831158369
- **Authorized official:** MRS. CHRISTINA A JETTON MD (PRESIDENT)
- **Authorized official phone:** (479) 968-6781

## Contact information

- **Practice address:** 1430 WEST C STREET, RUSSELLVILLE, AR 72801
- **Practice address phone:** (479) 968-6781
- **Practice address fax:** (479) 968-3074
- **Mailing address:** PO BOX 925, RUSSELLVILLE, AR 72811
- **Mailing address phone:** (479) 968-6781
- **Mailing address fax:** (479) 968-3074

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2006
- **Last updated:** 05/31/2024