Healthcare Provider Details

I. General information

NPI: 1609634633
Provider Name (Legal Business Name): FAST PACE KENTUCKY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 COLLEGE AVE
SPINDALE NC
28160-0016
US

IV. Provider business mailing address

PO BOX 306599
NASHVILLE TN
37230-6599
US

V. Phone/Fax

Practice location:
  • Phone: 828-330-9190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HARLAN
Title or Position: DIRECTOR, CREDENTIALING/ENROLLMENT
Credential:
Phone: 615-948-9639