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General NPI Number Information
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NPI Number | 1366003550
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Entity Type | Organization
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Legal Business Name | FAST PACE KENTUCKY PLLC
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 110 W JOHN ROWAN BLVD
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City | BARDSTOWN
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State | KY
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Zip | 40004-2663
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Country | US
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Telephone | 606-716-6017
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Fax | 606-261-2074
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Provider Business Mailing Address
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Address Line | PO BOX 681029
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City | FRANKLIN
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State | TN
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Zip | 37068-1029
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Country | US
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Telephone | 931-253-1110
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Fax |
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Authorized Official
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Title or Position | SR MANAGER
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Name | CHRISTY LITTLEJOHN
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Credential |
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Telephone | 931-253-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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