# KENTUCKIANA COLON AND RECTAL SURGERY, PLLC

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

## Provider details

- **NPI number:** 1619908613
- **Authorized official:** WAYNE TUCKSON MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (502) 583-8005

## Contact information

- **Practice address:** 4121 DUTCHMANS LN, SUITE 515, LOUISVILLE, KY 40207-4737
- **Practice address phone:** (502) 583-8005
- **Mailing address:** 4121 DUTCHMANS LN, SUITE 515, LOUISVILLE, KY 40207-4737
- **Mailing address phone:** (502) 583-8005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208C00000X | Colon & Rectal Surgery Physician | 30849 | KY | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/06/2006
- **Last updated:** 08/13/2008