MEDICARE: FAST PACE KENTUCKY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598335481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST PACE KENTUCKY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 306414
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6414
Country	:	US
Telephone Number	:	901-351-1791
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 NASHVILLE RD
Second Line	:
City	:	FRANKLIN
State	:	KY
Zip	:	42134-6961
Country	:	US
Telephone Number	:	901-351-1791
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SYDNI CLEMMONS
Credential	:
Telephone Number	:	901-351-1791

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/01/2021

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Directions to “FAST PACE KENTUCKY PLLC ” Practice Location

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