Individual
MR. KENNETH WAYNE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
405 E GEORGIA AVE, RUSTON, LA 71270-3926
(318) 251-4120
(318) 251-4181
Mailing address
802 MARION HWY, FARMERVILLE, LA 71241-9215
(318) 368-7283
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN106423
LA
Other
Enumeration date
06/18/2012
Last updated
06/18/2012
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