Healthcare Provider Details

I. General information

NPI: 1457716706
Provider Name (Legal Business Name): FAST PACE KENTUCKY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NASHVILLE RD
FRANKLIN KY
42134
US

IV. Provider business mailing address

5141 VIRGINIA WAY SUITE 390
BRENTWOOD TN
37027-7572
US

V. Phone/Fax

Practice location:
  • Phone: 270-813-1111
  • Fax: 270-813-1112
Mailing address:
  • Phone: 615-988-1571
  • Fax: 615-988-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. MATT DAVIS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 615-988-1574