Individual
MRS. KAITLYN DIANE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6400 DUTCHMANS PKWY STE 345, LOUISVILLE, KY 40205-3370
(502) 587-6010
(502) 587-1314
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 587-6010
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
006465
GA
363A00000X
Physician Assistant
—
KY
Other
Enumeration date
06/11/2012
Last updated
11/14/2020
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